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Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:544-547; doi:10.1136/jnnp.2005.074781
Copyright © 2006 by the BMJ Publishing Group Ltd.
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SHORT REPORT

Treatment of chronic inflammatory demyelinating polyradiculoneuropathy with methotrexate

D Fialho1, Y-C Chan1, D C Allen1, M M Reilly2, R A C Hughes1

1 Department of Clinical Neuroscience, King’s College London School of Medicine, UK
2 Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, National Hospital for Neurology and Institute of Neurology, London, UK

Correspondence to:
Correspondence to:
Dr D Fialho
Department of Molecular Neuroscience, Institute of Neurology, Queen Square, London WC1N 3BG, UK; doreen{at}doctors.org.uk


ABSTRACT
We discovered many reports of other immunosuppressive drugs being used in adults with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) but none of methotrexate. As weekly low dose oral methotrexate is safe, effective, and well tolerated in other diseases, we treated 10 patients with otherwise treatment resistant CIDP. Seven showed improvement in strength by at least two points on the MRC sum score and three worsened. Only two showed an improvement in disability and both were also receiving corticosteroids. We discuss the difficulty of detecting an improvement in treatment resistant CIDP and propose methotrexate as a suitable agent for testing in a randomised trial.

Abbreviations: CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; INCAT, Inflammatory Neuropathy Cause and Treatment; IVIg, intravenous immunoglobulin; MRC, Medical Research Council; ODSS, Overall Disability Sum Score

Keywords: peripheral neuropathy; chronic inflammatory demyelinating polyradiculoneuropathy; methotrexate; treatment






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