Lopate Glenn, Pestronk Alan, Al-Lozi Muhammad
Washington University School of Medicine, Department of Neurology, St Louis, MO 63110, USA.
Arch Neurol. 2005 Feb;62(2):249-54. doi: 10.1001/archneur.62.2.249.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) causes progressive disability due to weakness but responds to immunomodulating medication, including oral prednisone and intravenous (IV) immunoglobulin (IVIg). However, there is no consensus on initial therapy, and both of these treatments have drawbacks with long-term treatment.
To review the efficacy and safety of high-dose, intermittent IV methylprednisolone (IVMP) as initial and long-term maintenance therapy for patients with CIDP.
A retrospective medical record review between 1992 and 2003 of outcomes in CIDP, comparing patients in 3 cohorts depending on whether their primary treatment was IVMP, IVIg, or oral immunosuppression with prednisone or cyclosporine.
Washington University Neuromuscular Disease Center (St Louis, Mo), outpatient and inpatient records.
Patients with clinical and electrophysiologic evidence of CIDP were identified. Of 57 patients, 39 had sufficient data for full analysis.
Quantitative muscle testing with a handheld dynamometer. Medication profiles and adverse effects were also recorded.
There was no significant difference in the mean improvement in quantitative muscle testing at 6 months or at the last clinic visit (an average of 4.5 years later) among the 3 groups. Fewer patients treated with oral immunosuppression improved at 6 months, but at the last visit, 81% to 88% improved in all 3 groups. Less weight gain and fewer cushingoid features affected patients treated with IVMP (19%) compared with patients treated with oral prednisone (58%).
Treatment of patients with CIDP using high-dose intermittent IVMP results in improved strength equal to that with IVIg and oral prednisone. The frequency of occurrences of weight gain and cushingoid features with IVMP is less than that with oral prednisone. Intravenous methylprednisolone should be considered for initial and long-term therapy in CIDP when patients have disability due to weakness.
慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）因肌无力导致进行性残疾，但对免疫调节药物有反应，包括口服泼尼松和静脉注射免疫球蛋白（IVIg）。然而，对于初始治疗尚无共识，且这两种治疗方法在长期治疗中都有缺点。
回顾大剂量间歇性静脉注射甲泼尼龙（IVMP）作为CIDP患者初始和长期维持治疗的疗效和安全性。
对1992年至2003年CIDP患者的结局进行回顾性病历审查，根据患者的主要治疗方法是IVMP、IVIg还是口服泼尼松或环孢素进行免疫抑制，将患者分为3组进行比较。
华盛顿大学神经肌肉疾病中心（密苏里州圣路易斯），门诊和住院病历。
确定有CIDP临床和电生理证据的患者。57例患者中，39例有足够数据进行全面分析。
使用手持测力计进行定量肌肉测试。还记录了用药情况和不良反应。
3组患者在6个月时或最后一次门诊就诊时（平均4.5年后）定量肌肉测试的平均改善情况无显著差异。口服免疫抑制治疗的患者在6个月时改善较少，但在最后一次就诊时，所有3组的改善率均为81%至88%。与口服泼尼松治疗的患者（58%）相比，接受IVMP治疗的患者体重增加较少，库欣样特征较少（19%）。
使用大剂量间歇性IVMP治疗CIDP患者，其肌力改善程度与IVIg和口服泼尼松相当。IVMP导致体重增加和库欣样特征的发生率低于口服泼尼松。当患者因肌无力而残疾时，应考虑将静脉注射甲泼尼龙用于CIDP的初始和长期治疗。
