How to Treat CIDP

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a serious condition, but it’s treatable. The earlier you’re diagnosed and the earlier you start treatments, the better the chance you’ll have a good outcome.

Up to 80% of people with CIDP respond well to one or more of these treatments:

Corticosteroids

The first treatment used is often corticosteroids. They’re drugs that bring down inflammation and slow the immune system. It’s believed that in CIDP, the immune system damages the sheaths around nerves, called the myelin. Taken daily, corticosteroids can prevent that damage.

These medications have side effects, including high blood pressure, higher blood sugar, upset stomach, mood swings, irritability, restlessness, and weight gain. Some people are better able to manage the side effects than others.

Other drugs that suppress the immune system, such as azathioprine, can be used along with corticosteroids.

Plasma Exchange

In plasma exchange (PE), your blood is removed and the fluid portion of it (the plasma) is taken out and replaced with new plasma. That new plasma, along with the original blood cells and platelets, are put back in your body. This can slow your down your immune system.

It’s done by professionals at centers specializing in PE. A tube is placed in a large vein either in your neck or under your collarbone. You generally have to repeat PE five times, every other day, for 10 days.

One study found that 80% of people who get PE see a lot of improvement. But it lasts for only a few weeks at a time. And if the treatment is stopped early, you may lose the benefits.

PE can be expensive. Complications, though rare, can include an abnormal heartbeat, salt imbalances in the blood, infection, and bleeding.

PE can be used along with other treatments.

Intravenous Immunoglobulin

In IVIG, antibodies from healthy people are injected into a vein, usually in your forearm. It can slow your body’s immune system. Many people show improvement in their symptoms in 3 to 5 days after this treatment, and it can last up to 6 weeks. IVIG can be repeated as often as once a month.

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Side effects include headache, muscle aches, a rapid heartbeat, and high blood pressure, but these may be caused by the injection rather than the medication. Researchers are testing to see if injections of the solution under the skin, rather than intravenously, are as effective. That could lessen the side effects.

IVIG can be expensive, and in some areas, there’s limited availability of the medicine.

If your symptoms don’t improve from these treatments, or if you have multiple relapses or side effects that are unmanageable for you, there are other treatment possibilities:

Immunotherapies

Your doctor may prescribe more drugs that slow your immune system. These include azathioprine (Imuran), cyclophosphamide (Cytoxan), cyclosporine (Sandimmune), mycophenolate (CellCept), and tacrolimus.

Monoclonal Antibodies (MABs)

Drugs such as alemtuzumab (Lemtrada) and rituximab (Rituxan) are being studied for treating CIDP. The drugs target a specific defect in your cells. Studies suggest that may somehow keep the immune system from attacking the myelin.

Stem Cell Transplants

Some studies suggest that in rare cases, CIDP may be cured by using stem cell replacement, in which healthy cells -- either your own or donated from someone else -- are injected into your body. But there can be significant complications and side effects.

Living With CIPD

In addition to treatments, so-called “supportive therapies" can help you manage CIDP. These include things like using walkers and canes. Physical and occupational therapy can help with day-to-day activities. Moderate exercise may reduce fatigue and increase endurance. Over-the-counter remedies like ibuprofen and acetaminophen can help with pain.

When you have a serious condition like CIDP, it can take an emotional toll on you. Psychological counseling can help. You may also benefit by talking to others with CIDP. Ask your doctor about support groups in your area or online.

You can enjoy an active, healthy life with CIDP. They key is the right treatment plan.

WebMD Medical Reference Reviewed by Neil Lava, MD on November 24, 2018

Sources

SOURCES:

Gorson, K. Therapeutic Advances in Neurological Disorders, November 2012.

Cleveland Clinic: "Corticosteroids."

GBS/CIDP Foundation International.

National Organization for Rare Disorders: "Chronic Inflammatory Demyelinating Polyneuropathy."

Myasthenia Gravis Association of Western Pennsylvania: "Information on Plasma Exchange or Plasmapheresis."

Hahn, A. Brain: A Journal of Neurology, 1996.

Yoon, M. Therapeutic Advances in Neurological Disorders, May 2011.

Cancer Research UK: "About monoclonal antibodies."

Hirst, C. Journal of Neurology, Neurosurgery & Psychiatry, June 2006.

Center for Peripheral Neuropathy.

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