Treatment Issues
Carol L. Koski, M.D., Principal Author
During the past decade, the use of IGIV with its established efficacy and relative safety profile has changed the therapeutic approach to CIDP. (Dalakas, 1999; Dalakas, 2004) However, there are certain issues with all treatment modalities that are of importance to the practicing neurologist. This section will discuss a few of the prominent ones.
Overall Treatment Issues
The choice of which therapy to use to treat patients with CIDP (glucocoticoids, IVIG, Plasma exchange, or immunosuppressants) is judged against many variables: Just to name a few of those:
- Patient age
- Co-morbid disease(s)
- Safety
- Adverse events
- Long-term side effects
- Therapy costs
Therapy-Specific Issues
Read more about issues associated with specific treatment therapies:
Therapy Cost Issues
Cost is another factor when determining therapy. By far, the least expensive therapy is generic oral prednisone or IV prednisolone. However, the use of steroids is contraindicated in many patients, or they have experienced adverse events while being treated with such agents in the past. Long-term use of steroids can have serious sequelae, such as cataracts, diabetes, hypertension, osteoporosis, and obesity, of which both clinicians and patients should be aware. These potential side effects, along with frequent office visits, lost time from work, and other quality of life issues are all apart of the information the clinician must consider before deciding on a particular therapy. (McCrone, 2003)
During the past decade, the treatment evolution of CIDP has included biologic therapies, one of which is IGIV. In the United States, the established efficacy and relative safety profile of IGIV has allowed several private insurance companies, along with governmental insurance programs (Medicare and Medicaid) to cover the cost of IVIG therapy for CIDP. Recently, other new immunosuppressant products have been tried in CIDP patients, such as rituximab and azathioprine. Plasma Exchange (PE) is another treatment regime mentioned above for CIDP. Relatively speaking, these new products are all comparable in cost with one another.
