Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Neurology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
J Neurol. 2018 Sep;265(9):2052-2059. doi: 10.1007/s00415-018-8948-y. Epub 2018 Jul 2.
Chronic inflammatory demyelinating polyneuropathy (CIDP) can be treated with corticosteroids or intravenous immunoglobulins. Various corticosteroid regimens are currently used in CIDP, but it is unknown whether they are equally efficacious. In this retrospective study, we compared efficacy and safety of three corticosteroid regimens in CIDP patients.
We included treatment naïve patients that fulfilled the EFNS/PNS criteria for CIDP. Patients were treated with corticosteroids according to the local protocol of three CIDP expertise centres. Corticosteroid regimens consisted of daily oral prednisolone, pulsed oral dexamethasone, or pulsed intravenous methylprednisolone. Outcomes were number of responders to treatment, remission rate of treatment responders, overall probability of 5-year remission, and the occurrence of adverse events.
A total of 125 patients were included. Sixty-seven (54%) patients received daily prednisone or prednisolone, 37 (30%) pulsed dexamethasone, and 21 (17%) pulsed intravenous methylprednisolone. Overall, 60% (95% CI 51-69%) responded to corticosteroids, with no significant difference between the three treatment regimens (p = 0.56). From the 75 responders, 61% (95% CI 50-73%) remained in remission, during a median follow-up of 55 months (range 1-197 months). The probability of responders reaching 5-year remission was 55% (95% Cl 44-70%), with no difference between the three groups. Adverse events leading to a change in treatment occurred in ten patients (8%). Two patients had a serious adverse event.
Corticosteroids lead to improvement in 60% of patients and to remission in 61% of treatment responders. There were no differences between treatment modalities in terms of efficacy and safety.
慢性炎症性脱髓鞘性多发性神经病（CIDP）可以用皮质类固醇或静脉注射免疫球蛋白治疗。目前在 CIDP 中使用了各种皮质类固醇方案，但尚不清楚它们是否同样有效。在这项回顾性研究中，我们比较了 CIDP 患者三种皮质类固醇方案的疗效和安全性。
我们纳入了符合 EFNS/PNS CIDP 标准的初治患者。患者根据三个 CIDP 专业中心的当地方案接受皮质类固醇治疗。皮质类固醇方案包括每日口服泼尼松龙、脉冲口服地塞米松或脉冲静脉内甲基泼尼松龙。结局包括治疗应答者的数量、治疗应答者的缓解率、总体 5 年缓解率和不良事件的发生。
共纳入 125 例患者。67 例（54%）患者接受每日泼尼松龙或泼尼松治疗，37 例（30%）接受脉冲地塞米松治疗，21 例（17%）接受脉冲静脉内甲基泼尼松龙治疗。总体而言，60%（95%CI51-69%）对皮质类固醇有反应，三种治疗方案之间无显著差异（p=0.56）。在 75 名应答者中，75%（95%CI64-85%）在中位随访 55 个月（1-197 个月）内缓解。应答者达到 5 年缓解的概率为 55%（95%CI44-70%），三组之间无差异。因不良事件导致治疗改变的有 10 例（8%）。有 2 例发生严重不良事件。
皮质类固醇可使 60%的患者病情改善，使 61%的治疗应答者缓解。在疗效和安全性方面，三种治疗方式之间无差异。
