Corticosteroids
Carol L. Koski, M.D., Principal Author
Oral glucocorticoids are another initial treatment option. A six-week course of oral prednisone, starting at 60 mg daily, produced a benefit that was not significantly different than that seen by a single course of IVIG 2.0 g/kg. (Hughes, 2001)
Oral prednisone may be administered at 50 mg to 100 mg/day (usually 1mg/kg/day) for at least one month or until clinical improvement begins, followed by a gradual dose reduction of 5 mg every 2-4 weeks, to every other day therapy without disease breakthrough. The risk of recurrent symptoms when tapering the dose varies with disease types. However, with CIDP, relapse is more common in patients who have had their disease for greater than one year, and the relapse is greater in adults, more so than children. As noted in several studies (Lindenbau, 2001, Mehndiratta, 2001, and Van der Meche', 1995), up to 70% of patients relapse when the dose of prednisone is reduced.
In the Cochrane review (Van Schaik, 2002) mild and transient side effects were reported in 38 out of 99 (38%) IVIG patients, 9 out of 46 (20%) placebo-treated patients, and in 11 out of 27 (41%) prednisone-treated patients. Serious side-effects like, aseptic meningitis (1), transient hypertension (3), and heart failure (1) were encountered in 5 out of 99 (5%) IVIG patients, in 2 out of 46 (4%) placebo-treated patients, in 2 out of 27 (7%) prednisone-treated patients, and in 2 out of 17 (12%) plasmapheresis patients. These differences were not statistically significant. However, it should be noted that serious side-effects known to occur after prolonged treatment with steroids were not seen due to very short prednisone regimes given in this particular trial.
