Volume 72, Issue 2 pp. 201-211
INVITED REVIEW

Chronic Inflammatory Demyelinating Polyneuropathy: How Pathophysiology Can Guide Treatment

Karissa L. Gable

Corresponding Author

Karissa L. Gable

Duke University Medical Center, Durham, North Carolina, USA

Correspondence:

Karissa L. Gable ([email protected])

Contribution: Conceptualization, Writing - original draft, Writing - review & editing

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Yingkai Li

Yingkai Li

Duke University Medical Center, Durham, North Carolina, USA

Contribution: Writing - review & editing

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First published: 20 May 2025

Funding: The authors received no specific funding for this work.

The objectives of this activity are to: 1) Understand the roles of cell-mediated and humoral-mediated immunity in the pathogenesis of CIDP, in order to facilitate rational decision-making regarding therapies; 2) Understand the underlying pathogenetic mechanisms by which first line therapies (immunoglobulins, corticosteroids, and plasma exchange) may be effective in treating CIDP; 3) Understand how targeted therapies can be used to expand the treatment options for CIDP, and the mechanisms by which they do so.

The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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ABSTRACT

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune demyelinating neuropathy that is most commonly characterized clinically by progressive proximal and distal weakness affecting the upper and lower extremities, sensory loss, and reduced or absent reflexes. These symptoms evolve over the time course of 8 weeks or more. While the majority of CIDP demonstrates this clinical phenotype, there are CIDP variants as well. The milieu of the underlying pathophysiology and immunologic factors involved is complex and involves components of both the innate and adaptive immune systems. As more is understood about the underlying pathophysiology, novel targets and patterns have emerged guiding further classification and management. This is most notable in the discovery of antibodies targeting paranodal and nodal regions related to anti-neurofascin-155 and anti-contactin-1 antibody-mediated disease resulting in a reclassification as demyelinating nodo-paranodopathies. Triggering antigens and correlative antibodies for CIDP are otherwise undiscovered. While first-line therapies for CIDP currently are broad and non-targeted, a shift in approach has been to develop specific targeted treatments guided by what is understood about the underlying pathophysiology. Some of these targets include specific types of B-cell depletion, complement inhibition, immunoglobulin G (IgG) reduction via inhibition of the neonatal Fc receptor (FcRn) recycling of IgGs, treatments related to T-cell dysfunction, and macrophage inhibition.

Conflicts of Interest

Karissa L. Gable has served as a paid consultant for Immunovant, Sanofi, Takeda, CSL Behring, Grifols, Argenx, Annexon and Dianthus, and InCircle. The other author declares no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

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