Article

Improvement of therapeutic strategies for peripheral neuropathies requires
multicentric clinical trials.
For chronic inflammatory demyelinating
polyradiculoneuropathy (CIDP), a randomized controlled multicentric study
compared IgIV to pulses of methylprednisolone (MP) given for 6 months. The
primary endpoint was treatment discontinuation due to inefficacy or intolerance;
45 patients were enrolled: more patients had interrupted MP than IVIg, usually
because of inefficacy. A multicentric randomized clinical trial (PREDICT)
evaluated long-term remission of CIDP after short-term corticosteroid therapy
(pulses of dexamethasone or prednisolone); 39 patients were enrolled: 26%
achieved cure or remission, a relapse occurred in 50% after a delay of 11 to 17
months. Differential diagnosis was identified in 58% of patients who had not
responded to any therapy. For refractory CIDP, a retrospective study showed the
possibility of functional improvement in 24% of cases after adjunction of an
immunomodulatory agent; cyclosporine was associated with the highest rate of
adverse events or side effects. In familial amyloidotic polyneuropathy, a
multicentric controlled study against placebo with tafamidis, an akinetic
stabilizer of transthyretin (TTR) 20mg/d, in early stage of Val30MetTTR showed
efficiency in the evaluable group and led to marketing authorization by the EMA
in stage 1 to slow the progression of the neuropathy. A Cochrane database system
review showed that there are no randomized or quasi-randomized controlled
clinical trials of treatment for POEMS syndrome, for neuropathies with anti-MAG
antibodies, or multifocal motor neuropathy on which to base practice. This review
underlines the usefulness of multicentric randomized trials to assess treatments
in peripheral neuropathies.
CI - Copyright (c) 2013 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS