The changing landscape of primary autoimmune neuropathies

Autoimmune neuropathies, such as Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), are rare, disabling disorders. Diagnosis, follow-up and treatment of autoimmune neuropathies rely almost exclusively on clinical parameters, and the available therapies, such as intravenous immunoglobulins and corticosteroids, date from >30 years ago. The lack of therapeutic progress in autoimmune neuropathies has resulted from a combination of limited understanding of their pathophysiology, disease heterogeneity and challenges in trial design. However, advances in the past 5 years are set to change the rate of progress. The discovery of pathogenic autoantibodies that target cell-adhesion molecules at the node of Ranvier, thereby defining the new diagnostic category of autoimmune nodopathies, has provided a new perspective on disease pathophysiology. In addition, better definitions of the diagnostic criteria for GBS and CIDP, FDA approval of efgartigimod for the treatment of CIDP, promising results in trials of complement inhibitors in CIDP, GBS and multifocal motor neuropathy and the identification of biomarkers with the potential to optimize prognostication and monitoring are moving us towards targeted and precise therapeutic approaches to improve outcomes of autoimmune neuropathies. In this Review, we summarize the latest developments in autoimmune neuropathies, including discoveries in disease mechanisms, the implications of new diagnostic guidelines, identification of new biomarkers and the status of the most promising clinical trials.