129th ENMC International Workshop: Clinical Trials for Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy, 27th October 2004, Schiphol airport, The Netherlands

Abstract

There is uncertainty about the best immunosuppressive treatments for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) and consequently a wide variation in practice. CIDP affects between 2 and 8 per 100,000 and MMN has a prevalence about 10 times lower. Both conditions are economically important because intravenous immunoglobulin (IVIg) is often used in their treatment and is very expensive especially because of the need for repeated courses. Multicentre trials are necessary to provide sufficient participants for adequately powered trials and need to be conducted at a multinational level. The evidence for treatment has been systematically reviewed in Cochrane reviews [1,2] and a previous ENMC workshop had already considered MMN [3]. In CIDP steroids, IVIg or plasma exchange (PE) and in MMN IVIg provide short-term benefit but the value of immunosuppressant treatment has not been adequately evaluated. Encouragingly there are four ongoing trials in CIDP and one in MMN. A Bayer trial compares IVIg with placebo over a longer period than has been tested before (M MaasEnriquez, personal communication). A Biogen-Idec trial tests whether interferon-beta 1a will reduce the requirement for IVIg [4]. A Dutch trial aims to find out whether pulsed high dose dexamethasone induces remissions more often and more rapidly and is more effective than standard prednisolone treatment (I van Schaik personal communication). An Italian trial aims to compare IVIg and high dose