Steroids or immunoglobulin for CIDP first-line treatment: why not both?

In Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), 81% of patients respond well to at least one of the established first-line therapies: corticosteroids, immunoglobulin or plasma exchange (PLEX).1 2 However, studies comparing their efficacy and tolerability are limited. Nobile-Orazio et al showed response at 6 months to either pulsed intravenous methylprednisolone (IVMP) or intravenous immunoglobulin (IVIg) was equivalent, but improvement was seen earlier with IVIg (6 weeks vs 3 months with IVMP).3 Importantly, none of the IVMP responders relapsed on discontinuation but almost 40% of IVIg responders required ongoing regular infusions to maintain response.3