[Recent advances of immune therapies for demyelinating neuropathies]

Most of acquired demyelinating neuropathies are caused by immune-mediated processes. Therefore, we can treat these neuropathies to control underlying immune abnormality. We review the recent therapies and show possible strategies in the future. (1) Recent therapies Guillain-Barré syndrome should be treated quickly and intensively in the first week of the disease with plasmapheresis (PP). Intravenous immunoglobulin (IVIG) is as effective as PP. IVIG is under phase 3 clinical trial in Japan. Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated with corticosteroids, PP or IVIG. Corticosteroids or PP is the first choice. For severe or resistant cases, combined therapy or immunosuppressants, such as cyclophosphamide pulse therapy, should be considered. Polyneuropathy with IgM-MGUS (monoclonal gammopathies of undetermined significance) is treated with PP, immunosuppressants or these combinations to decrease serum IgM, especially for cases with anti-MAG antibody, because the autoantibody induces demyelination by itself. (2) Future strategies Immunopathogenesis may differ among cases with Guillain-Barré syndrome or CIDP. The best therapy will be chosen individually, according to appropriate immunologic tests. In CIDP, immunomodulation therapies, that are similar ones in multiple sclerosis, will be considered to maintain improvement.