Fludarabine in the Treatment of Refractory Chronic Inflammatory Demyelinating Neuropathy. Leitch, Megan M. MD; Sherman, William H. MD; Brannagan, Thomas H. III MD. Journal of Clinical Neuromuscular Disease. 2015;17:1-5.
Submitted by David R. Mayans, MD, News Science Editorial Board
Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated most commonly with oral steroids and intravenous immunoglobulin. Options for patients with refractory disease include plasmapheresis, cyclophosphamide, azathioprine, mycophenylate mofeteil, and rituximab. Up to one third of patients with CIDP have a poor response to treatment, particularly patients with anti-MAG antibodies. Fludarabine is a nucleoside analong antimetabolite which incorporates into DNA and induces apoptosis. It predominately affects B1 lymphocytes and has been shown to be helpful in IgM-related CIDP. This article describes a case series of 8 patients with CIDP treated with fludarabine at a dose of 25mg/m2 per day for 5 days every 5-8 weeks. Improvement was noted in all 8 patients. Fludarabine was generally well tolerated but two patients had hematologic side effects necessitating treatment discontinuation.
COMMENT: Corticosteroids and intravenous immunoglobulin are effective in only 60-70% of patients with CIDP. Fludarabine has shown efficacy in the treatment of CIDP associated with monoclonal gammopathy and distal acquired demyelinating symmetric neuropathy, and may be an option for patients with refractory disease.
About the News Science Editorial Board
The board helps to highlight significant, timely science news items for AANEM members. It reviews articles in journals and websites, identifies newsworthy items in the field, and writes article summaries.