Immunotherapy for IgM anti-myelin-associated glycoprotein paraprotein-associated peripheral neuropathies

There is insufficient evidence on longer-term benefits of immunotherapies in anti-myelin associated glycoprotein paraproteinaemic peripheral neuropathy.

A Cochrane review included 5 studies with a total of 97 subjects with anti-myelin-associated glycoprotein antibody associated demyelinating peripheral neuropathy. The tested immunotherapies were intravenous immunoglobulin, interferon-alpha or plasma exchange. Only two, of intravenous immunoglobulin, had comparable interventions and outcomes but both were short-term. There were no significant benefits of the treatments as measured by Neuropathy Impairment Scale or Modified Rankin Scale at six months after randomisation. Intravenous immunoglobulin showed benefits in terms of improvement in Modified Rankin Scale at two weeks and 10-metre walk time at four weeks. Serious adverse effects of intravenous immunoglobulin are known to occur from observational studies but none were encountered in these trials.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison), by inconsistency (heterogeneity in interventions and outcomes) and by indirectness (sensitive and validated clinical and disability scales were not used in most studies; short study durations).

Ədəbiyyat

1. Lunn MP, Nobile-Orazio E. Immunotherapy for IgM anti-myelin-associated glycoprotein paraprotein-associated peripheral neuropathies. Cochrane Database Syst Rev 2006 Apr 19;(2):CD002827.