Immunosuppressive treatment for multifocal motor neuropathy

In multifocal motor neuropathy mycophenolate mofetil might possibly not be beneficial. There is no evidence from randomised controlled trials of other immunosuppressive treatments.

A Cochrane review included one RCT with 28 patients. In this mycophenolate mofetil trial, where patients also received regular intravenous human immunoglobulin (IVIg) there was no benefit either in terms of improvement in functional scales or in reduction of IVIg requirement. In addition, data from a mixture of controlled trials, case series and anecdotal experience have established IVIg as the first-line treatment for multifocal motor neuropathy. The available non-randomised evidence suggests a possible therapeutic role of cyclophosphamide in the primary treatment of multifocal motor neuropathy, provided it is given at an adequate dose, but at a cost of significant adverse effects. The efficacy of other immunosuppressants (ciclosporin, azathioprine, rituximab, mycophenolate mofetil) remains unclear. Corticosteroids and plasma exchange are probably ineffective.

Comment: The quality of evidence is downgraded by imprecise results (one small RCT), inconsistency (heterogeneity in treatments) and study quality (mostly non-RCTs included in the review).

Ədəbiyyat

1. Umapathi T, Hughes RA, Nobile-Orazio E et al. Immunosuppressant and immunomodulatory treatments for multifocal motor neuropathy. Cochrane Database Syst Rev 2015;3():CD003217.