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Immunomodulatory Drugs and Intravenous Immunoglobulin (IVIg) for Patients with Chronic Demyelinating Polyneuropathy Who Are in Remission: A Review of Clinical and Cost-effectiveness and Guidelines

Last updated: March 13, 2015
Project Number: RC0639-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of using either immunomodulatory drugs alone or as adjunctive treatment to intravenous immunoglobulin (IVIg) therapy in patients with chronic demyelinating polyneuropathy (CIDP) who are in remission?
  2. What is the cost-effectiveness of using either immunomodulatory drugs alone or as adjunctive treatment to IVIg therapy in patients with CIDP who are in remission?
  3. What are the guidelines associated with the use of either immunomodulatory drugs alone or as adjunctive treatment to IVIg therapy in patients with CIDP who are in remission?

Key Message

The efficacy, safety and cost-effectiveness of immunomodulatory drugs remain largely unclear given the limited number of studies that were identified. Two studies met the inclusion criteria for this review. One was a systematic review of randomized and quasi-randomized studies while the other was a European clinical practice guideline that covered the diagnosis and treatment of CIDP. Among the trials identified within the systematic review, no significant benefit from interferon beta-1a or methotrexate was observed in patients receiving these immunomodulators as an adjunctive agent to IVIg. Based on consensus reached by clinical experts, the clinical practice guideline recommended adding an immunosuppressant or immunomodulator only if response to therapy is inadequate or if one desires a lower dose of the maintenance therapy, and the remaining first-line treatments alternatives have been tried without success.