Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder affecting the nerves. Diagnosis can be challenging due to overlapping symptoms with Guillain-Barré Syndrome (GBS) – often, CIDP is suspected when symptoms persist beyond eight weeks. Once correctly identified, effective treatment is possible, though requires careful management.
First-Line Treatments: The Standard Approach
The most commonly used and evidence-backed treatments for CIDP include plasma exchange, intravenous immunoglobulin (IVIG), and corticosteroids. Doctors select the best approach based on symptom severity, nerve damage, and individual patient response.
- Corticosteroids: While effective at reducing inflammation, long-term use carries significant risks, including osteoporosis, high blood pressure, and diabetes. For this reason, they are not ideal for chronic management.
- Plasma Exchange (Plasmapheresis): This involves removing harmful antibodies from the blood and replacing them with healthy plasma. It can be effective, but is labor-intensive and provides relief for only a few weeks at a time.
- IVIG/SCIg Therapy: Infusing or injecting immunoglobulins can help calm the immune system’s attack on nerves. Like plasma exchange, the effects are temporary, requiring ongoing treatment.
When First-Line Treatments Fail: Second-Line Options
If initial treatments prove ineffective or cause unacceptable side effects, alternative approaches are available. These include:
- FcRn Inhibitors: These medications reduce levels of damaging antibodies. They can be administered intravenously or through subcutaneous injections at home.
- B Cell Inhibitors: Blocking B cells—which produce antibodies—can help manage the autoimmune response in CIDP.
- Immunosuppressants: These drugs further suppress the overactive immune system.
Supportive Therapies: Enhancing Quality of Life
Alongside medication, physical and occupational therapy are critical. Physical therapy maintains mobility and reduces pain, while occupational therapy helps patients adapt to changing symptoms and stay independent. Assistive devices like braces, canes, and walkers can further support function and safety.
“Appropriate use of rehabilitation and assistive devices is just as important as medication in maximizing a patient’s quality of life,” says Dr. Richard Lewis, a neurologist at Cedars-Sinai.
Conclusion
CIDP management requires a tailored approach, starting with first-line treatments like corticosteroids, plasma exchange, or IVIG. If these fail, second-line therapies and supportive care – including physical and occupational therapy – can significantly improve outcomes. Working closely with a neurologist is essential for optimizing treatment and enhancing long-term quality of life.
