European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision (2024)

Abstract

To revise the 2010 consensus guideline on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Seventeen disease experts, a patient representative, and two Cochrane methodologists constructed 12 Population/Intervention/Comparison/Outcome (PICO) questions regarding diagnosis and treatment to guide the literature search. Data were extracted and summarized in GRADE summary of findings (for treatment PICOs) or evidence tables (for diagnostic PICOs). Statements were prepared according to the GRADE Evidence-to-Decision frameworks. Typical CIDP and CIDP variants were distinguished. The previous term “atypical CIDP” was replaced by “CIDP variants” because these are well characterized entities (multifocal, focal, distal, motor, or sensory CIDP). The levels of diagnostic certainty were reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP), because the diagnostic accuracy of criteria for probable and definite CIDP did not significantly differ. Good Practice Points were formulated for supportive criteria and investigations to be considered to diagnose CIDP. The principal treatment recommendations were: (a) intravenous immunoglobulin (IVIg) or corticosteroids are strongly recommended as initial treatment in typical CIDP and CIDP variants; (b) plasma exchange is strongly recommended if IVIg and corticosteroids are ineffective; (c) IVIg should be considered as first-line treatment in motor CIDP (Good Practice Point); (d) for maintenance treatment, IVIg, subcutaneous immunoglobulin or corticosteroids are recommended; (e) if the maintenance dose of any of these is high, consider either combination treatments or adding an immunosuppressant or immunomodulatory drug (Good Practice Point); and (f) if pain is present, consider drugs against neuropathic pain and multidisciplinary management (Good Practice Point).

Original languageEnglish
Pages (from-to)242-268
Number of pages27
JournalJournal of the Peripheral Nervous System
Volume26
Issue number3
Early online date4 Jun 2021
DOIs
Publication statusPublished - 1 Sept 2021

Bibliographical note

Funding Information:
The CIDP Guideline Task Force is grateful to the European Academy of Neurology (EAN), the Peripheral Nerve Society (PNS), the GBS/CIDP Foundation International and the GAIN Charity UK for granting unrestricted financial support. Date of EAN approval: May 14, 2021.

Funding Information:
P. Y. K. Van den B. reports honoraria, consultancy fees, advisory boards from Pfizer, Genzyme, CSL Behring, LFB, Natus, UCB Pharma, Alnylam Pharmaceuticals. P. A. van D. reports grants from Baxalta, Sanquin, Prinses Beatrix Spierfonds, Talecris. R. D. M. H. reports honoraria, consultancy, travel expenses, and departmental donations from Alnylam, Argenx, Grifols, and CSL Behring. B. A. has nothing to disclose. P. V. fees for consultancy and advisory boards (all to department) from: Annexon, Argenx, Hansa, Immunic, Octapharma, Roche. J. A. A. reports grants from CSL Behring and consultancy from CSL Behring, Grifols, Biopharma, Biotest. S. A. reports grants and honoraria from LFB, Pfizer, CSL Behring. P. H. P. H. B. has nothing to disclose. D. R. C. reports consultancy fees from Acetylon Pharmaceuticals, Alnylam Pharmaceuticals, Annexon Biosciences, Akros Pharma, Biotest Pharmaceuticals, Boehringer Ingelheim, Cigna Health Management, CSL Behring, DP Clinical, Grifols, Karos Pharmaceuticals, Neurocrine Biosciences, Novartis, Octapharma, Pharnext, Sun Pharmaceuticals, Syntimmune, and stock options from Syntimmune. F. E. reports grants from Prinses Beatrix Spierfonds, ZonMw, and consultancy from Astellas, UCB Pharma. H. S. G. reports grants from Prinses Beatrix Spierfonds. T. H. has nothing to disclose. S. K. reports Kakenhi grants from the Ministry of Welfare in Japan. R. A. L. reports consultancy fees from CSL Behring, Grifols, Optioncare, Kedrion, Biotest, Axelacare, Pharnext. M. P. L. reports consultancy fees from Octapharma, CSL Behring and a patent for antiganglioside antibodies licenced to Fujierbo (Johns Hopkins Hospital). E. N.‐O. reports consulting fee, honorarium, and advisory/scientific boards from Argenx, Belgium; Astellas, the Netherlands; Baxter/Takeda, Italy, and United States; CSL Behring, Italy, and Switzerland; Grifols, Spain; Janssen, united States; Kedrion, Italy; LFB, France; Novartis, Switzerland; Roche, Switzerland; Sanofi, united States; UCB,UK. L. Q. reports grants and consultancy fees from Grifols, Novartis. Y. A. R. reports grants from LFB and consultancy fees from LFB, CSL Behring. C. S. reports grants from Kedrion, consultancy fees from Airliquidw, Alnylam Pharmaceuticals. H. A. T. reports grants from EU‐Tubitak.

Publisher Copyright:
© 2021 European Academy of Neurology and Peripheral Nerve Society.

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Van den Bergh, P. Y. K., van Doorn, P. A., Hadden, R. D. M., Avau, B., Vankrunkelsven, P., Allen, J. A., Attarian, S., Blomkwist-Markens, P. H., Cornblath, D. R., Eftimov, F., Goedee, H. S., Harbo, T., Kuwabara, S., Lewis, R. A., Lunn, M. P., Nobile-Orazio, E., Querol, L., Rajabally, Y. A., Sommer, C., & Topaloglu, H. A. (2021). European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision. Journal of the Peripheral Nervous System, 26(3), 242-268. https://doi.org/10.1111/jns.12455

Van den Bergh, Peter Y.K. ; van Doorn, Pieter A. ; Hadden, Robert D.M. et al. / European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy : Report of a joint Task Force—Second revision. In: Journal of the Peripheral Nervous System. 2021 ; Vol. 26, No. 3. pp. 242-268.

@article{0fd1ba3522a04f32a7bc649175d9a69d,

title = "European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision",

abstract = "To revise the 2010 consensus guideline on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Seventeen disease experts, a patient representative, and two Cochrane methodologists constructed 12 Population/Intervention/Comparison/Outcome (PICO) questions regarding diagnosis and treatment to guide the literature search. Data were extracted and summarized in GRADE summary of findings (for treatment PICOs) or evidence tables (for diagnostic PICOs). Statements were prepared according to the GRADE Evidence-to-Decision frameworks. Typical CIDP and CIDP variants were distinguished. The previous term “atypical CIDP” was replaced by “CIDP variants” because these are well characterized entities (multifocal, focal, distal, motor, or sensory CIDP). The levels of diagnostic certainty were reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP), because the diagnostic accuracy of criteria for probable and definite CIDP did not significantly differ. Good Practice Points were formulated for supportive criteria and investigations to be considered to diagnose CIDP. The principal treatment recommendations were: (a) intravenous immunoglobulin (IVIg) or corticosteroids are strongly recommended as initial treatment in typical CIDP and CIDP variants; (b) plasma exchange is strongly recommended if IVIg and corticosteroids are ineffective; (c) IVIg should be considered as first-line treatment in motor CIDP (Good Practice Point); (d) for maintenance treatment, IVIg, subcutaneous immunoglobulin or corticosteroids are recommended; (e) if the maintenance dose of any of these is high, consider either combination treatments or adding an immunosuppressant or immunomodulatory drug (Good Practice Point); and (f) if pain is present, consider drugs against neuropathic pain and multidisciplinary management (Good Practice Point).",

author = "{Van den Bergh}, {Peter Y.K.} and {van Doorn}, {Pieter A.} and Hadden, {Robert D.M.} and Bert Avau and Patrik Vankrunkelsven and Allen, {Jeffrey A.} and Shahram Attarian and Blomkwist-Markens, {Patricia H.} and Cornblath, {David R.} and Filip Eftimov and Goedee, {H. Stephan} and Thomas Harbo and Satoshi Kuwabara and Lewis, {Richard A.} and Lunn, {Michael P.} and Eduardo Nobile-Orazio and Luis Querol and Rajabally, {Yusuf A.} and Claudia Sommer and Topaloglu, {Haluk A.}",

note = "Funding Information: The CIDP Guideline Task Force is grateful to the European Academy of Neurology (EAN), the Peripheral Nerve Society (PNS), the GBS/CIDP Foundation International and the GAIN Charity UK for granting unrestricted financial support. Date of EAN approval: May 14, 2021. Funding Information: P. Y. K. Van den B. reports honoraria, consultancy fees, advisory boards from Pfizer, Genzyme, CSL Behring, LFB, Natus, UCB Pharma, Alnylam Pharmaceuticals. P. A. van D. reports grants from Baxalta, Sanquin, Prinses Beatrix Spierfonds, Talecris. R. D. M. H. reports honoraria, consultancy, travel expenses, and departmental donations from Alnylam, Argenx, Grifols, and CSL Behring. B. A. has nothing to disclose. P. V. fees for consultancy and advisory boards (all to department) from: Annexon, Argenx, Hansa, Immunic, Octapharma, Roche. J. A. A. reports grants from CSL Behring and consultancy from CSL Behring, Grifols, Biopharma, Biotest. S. A. reports grants and honoraria from LFB, Pfizer, CSL Behring. P. H. P. H. B. has nothing to disclose. D. R. C. reports consultancy fees from Acetylon Pharmaceuticals, Alnylam Pharmaceuticals, Annexon Biosciences, Akros Pharma, Biotest Pharmaceuticals, Boehringer Ingelheim, Cigna Health Management, CSL Behring, DP Clinical, Grifols, Karos Pharmaceuticals, Neurocrine Biosciences, Novartis, Octapharma, Pharnext, Sun Pharmaceuticals, Syntimmune, and stock options from Syntimmune. F. E. reports grants from Prinses Beatrix Spierfonds, ZonMw, and consultancy from Astellas, UCB Pharma. H. S. G. reports grants from Prinses Beatrix Spierfonds. T. H. has nothing to disclose. S. K. reports Kakenhi grants from the Ministry of Welfare in Japan. R. A. L. reports consultancy fees from CSL Behring, Grifols, Optioncare, Kedrion, Biotest, Axelacare, Pharnext. M. P. L. reports consultancy fees from Octapharma, CSL Behring and a patent for antiganglioside antibodies licenced to Fujierbo (Johns Hopkins Hospital). E. N.‐O. reports consulting fee, honorarium, and advisory/scientific boards from Argenx, Belgium; Astellas, the Netherlands; Baxter/Takeda, Italy, and United States; CSL Behring, Italy, and Switzerland; Grifols, Spain; Janssen, united States; Kedrion, Italy; LFB, France; Novartis, Switzerland; Roche, Switzerland; Sanofi, united States; UCB,UK. L. Q. reports grants and consultancy fees from Grifols, Novartis. Y. A. R. reports grants from LFB and consultancy fees from LFB, CSL Behring. C. S. reports grants from Kedrion, consultancy fees from Airliquidw, Alnylam Pharmaceuticals. H. A. T. reports grants from EU‐Tubitak. Publisher Copyright: {\textcopyright} 2021 European Academy of Neurology and Peripheral Nerve Society.",

year = "2021",

month = sep,

day = "1",

doi = "10.1111/jns.12455",

language = "English",

volume = "26",

pages = "242--268",

journal = "Journal of the Peripheral Nervous System",

issn = "1085-9489",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "3",

}

Van den Bergh, PYK, van Doorn, PA, Hadden, RDM, Avau, B, Vankrunkelsven, P, Allen, JA, Attarian, S, Blomkwist-Markens, PH, Cornblath, DR, Eftimov, F, Goedee, HS, Harbo, T, Kuwabara, S, Lewis, RA, Lunn, MP, Nobile-Orazio, E, Querol, L, Rajabally, YA, Sommer, C & Topaloglu, HA 2021, 'European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision', Journal of the Peripheral Nervous System, vol. 26, no. 3, pp. 242-268. https://doi.org/10.1111/jns.12455

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision. / Van den Bergh, Peter Y.K.; van Doorn, Pieter A.; Hadden, Robert D.M. et al.
In: Journal of the Peripheral Nervous System, Vol. 26, No. 3, 01.09.2021, p. 242-268.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy

T2 - Report of a joint Task Force—Second revision

AU - Van den Bergh, Peter Y.K.

AU - van Doorn, Pieter A.

AU - Hadden, Robert D.M.

AU - Avau, Bert

AU - Vankrunkelsven, Patrik

AU - Allen, Jeffrey A.

AU - Attarian, Shahram

AU - Blomkwist-Markens, Patricia H.

AU - Cornblath, David R.

AU - Eftimov, Filip

AU - Goedee, H. Stephan

AU - Harbo, Thomas

AU - Kuwabara, Satoshi

AU - Lewis, Richard A.

AU - Lunn, Michael P.

AU - Nobile-Orazio, Eduardo

AU - Querol, Luis

AU - Rajabally, Yusuf A.

AU - Sommer, Claudia

AU - Topaloglu, Haluk A.

N1 - Funding Information:The CIDP Guideline Task Force is grateful to the European Academy of Neurology (EAN), the Peripheral Nerve Society (PNS), the GBS/CIDP Foundation International and the GAIN Charity UK for granting unrestricted financial support. Date of EAN approval: May 14, 2021. Funding Information:P. Y. K. Van den B. reports honoraria, consultancy fees, advisory boards from Pfizer, Genzyme, CSL Behring, LFB, Natus, UCB Pharma, Alnylam Pharmaceuticals. P. A. van D. reports grants from Baxalta, Sanquin, Prinses Beatrix Spierfonds, Talecris. R. D. M. H. reports honoraria, consultancy, travel expenses, and departmental donations from Alnylam, Argenx, Grifols, and CSL Behring. B. A. has nothing to disclose. P. V. fees for consultancy and advisory boards (all to department) from: Annexon, Argenx, Hansa, Immunic, Octapharma, Roche. J. A. A. reports grants from CSL Behring and consultancy from CSL Behring, Grifols, Biopharma, Biotest. S. A. reports grants and honoraria from LFB, Pfizer, CSL Behring. P. H. P. H. B. has nothing to disclose. D. R. C. reports consultancy fees from Acetylon Pharmaceuticals, Alnylam Pharmaceuticals, Annexon Biosciences, Akros Pharma, Biotest Pharmaceuticals, Boehringer Ingelheim, Cigna Health Management, CSL Behring, DP Clinical, Grifols, Karos Pharmaceuticals, Neurocrine Biosciences, Novartis, Octapharma, Pharnext, Sun Pharmaceuticals, Syntimmune, and stock options from Syntimmune. F. E. reports grants from Prinses Beatrix Spierfonds, ZonMw, and consultancy from Astellas, UCB Pharma. H. S. G. reports grants from Prinses Beatrix Spierfonds. T. H. has nothing to disclose. S. K. reports Kakenhi grants from the Ministry of Welfare in Japan. R. A. L. reports consultancy fees from CSL Behring, Grifols, Optioncare, Kedrion, Biotest, Axelacare, Pharnext. M. P. L. reports consultancy fees from Octapharma, CSL Behring and a patent for antiganglioside antibodies licenced to Fujierbo (Johns Hopkins Hospital). E. N.‐O. reports consulting fee, honorarium, and advisory/scientific boards from Argenx, Belgium; Astellas, the Netherlands; Baxter/Takeda, Italy, and United States; CSL Behring, Italy, and Switzerland; Grifols, Spain; Janssen, united States; Kedrion, Italy; LFB, France; Novartis, Switzerland; Roche, Switzerland; Sanofi, united States; UCB,UK. L. Q. reports grants and consultancy fees from Grifols, Novartis. Y. A. R. reports grants from LFB and consultancy fees from LFB, CSL Behring. C. S. reports grants from Kedrion, consultancy fees from Airliquidw, Alnylam Pharmaceuticals. H. A. T. reports grants from EU‐Tubitak. Publisher Copyright:© 2021 European Academy of Neurology and Peripheral Nerve Society.

PY - 2021/9/1

Y1 - 2021/9/1

N2 - To revise the 2010 consensus guideline on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Seventeen disease experts, a patient representative, and two Cochrane methodologists constructed 12 Population/Intervention/Comparison/Outcome (PICO) questions regarding diagnosis and treatment to guide the literature search. Data were extracted and summarized in GRADE summary of findings (for treatment PICOs) or evidence tables (for diagnostic PICOs). Statements were prepared according to the GRADE Evidence-to-Decision frameworks. Typical CIDP and CIDP variants were distinguished. The previous term “atypical CIDP” was replaced by “CIDP variants” because these are well characterized entities (multifocal, focal, distal, motor, or sensory CIDP). The levels of diagnostic certainty were reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP), because the diagnostic accuracy of criteria for probable and definite CIDP did not significantly differ. Good Practice Points were formulated for supportive criteria and investigations to be considered to diagnose CIDP. The principal treatment recommendations were: (a) intravenous immunoglobulin (IVIg) or corticosteroids are strongly recommended as initial treatment in typical CIDP and CIDP variants; (b) plasma exchange is strongly recommended if IVIg and corticosteroids are ineffective; (c) IVIg should be considered as first-line treatment in motor CIDP (Good Practice Point); (d) for maintenance treatment, IVIg, subcutaneous immunoglobulin or corticosteroids are recommended; (e) if the maintenance dose of any of these is high, consider either combination treatments or adding an immunosuppressant or immunomodulatory drug (Good Practice Point); and (f) if pain is present, consider drugs against neuropathic pain and multidisciplinary management (Good Practice Point).

AB - To revise the 2010 consensus guideline on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Seventeen disease experts, a patient representative, and two Cochrane methodologists constructed 12 Population/Intervention/Comparison/Outcome (PICO) questions regarding diagnosis and treatment to guide the literature search. Data were extracted and summarized in GRADE summary of findings (for treatment PICOs) or evidence tables (for diagnostic PICOs). Statements were prepared according to the GRADE Evidence-to-Decision frameworks. Typical CIDP and CIDP variants were distinguished. The previous term “atypical CIDP” was replaced by “CIDP variants” because these are well characterized entities (multifocal, focal, distal, motor, or sensory CIDP). The levels of diagnostic certainty were reduced from three (definite, probable, possible CIDP) to only two (CIDP and possible CIDP), because the diagnostic accuracy of criteria for probable and definite CIDP did not significantly differ. Good Practice Points were formulated for supportive criteria and investigations to be considered to diagnose CIDP. The principal treatment recommendations were: (a) intravenous immunoglobulin (IVIg) or corticosteroids are strongly recommended as initial treatment in typical CIDP and CIDP variants; (b) plasma exchange is strongly recommended if IVIg and corticosteroids are ineffective; (c) IVIg should be considered as first-line treatment in motor CIDP (Good Practice Point); (d) for maintenance treatment, IVIg, subcutaneous immunoglobulin or corticosteroids are recommended; (e) if the maintenance dose of any of these is high, consider either combination treatments or adding an immunosuppressant or immunomodulatory drug (Good Practice Point); and (f) if pain is present, consider drugs against neuropathic pain and multidisciplinary management (Good Practice Point).

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U2 - 10.1111/jns.12455

DO - 10.1111/jns.12455

M3 - Article

C2 - 34085743

AN - SCOPUS:85109045064

SN - 1085-9489

VL - 26

SP - 242

EP - 268

JO - Journal of the Peripheral Nervous System

JF - Journal of the Peripheral Nervous System

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Van den Bergh PYK, van Doorn PA, Hadden RDM, Avau B, Vankrunkelsven P, Allen JA et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision. Journal of the Peripheral Nervous System. 2021 Sept 1;26(3):242-268. Epub 2021 Jun 4. doi: 10.1111/jns.12455

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision (2024)

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