Data di Pubblicazione:
2007
Citazione:
Treatment for IgG and IgA paraproteinemic neuropathy / D. Allen, M.P.T. Lunn, J. Niermeijer, E. Nobile-Orazio. - In: COCHRANE DATABASE OF SYSTEMATIC REVIEWS. - ISSN 1469-493X. - 1:1(2007), p. CD005376.Art. No.: CD005376. DOI: 10.1002/14651858.CD005376.pub2..
Abstract:
Background
Paraproteinaemic neuropathy refers to those neuropathies associated with a monoclonal gammopathy or paraprotein. Typically it
presents with a chronic predominantly sensory, symmetrical neuropathy, similar to chronic inflammatory demyelinating polyradiculoneuropathy but with relatively more sensory involvement, both clinically and neurophysiologically. The optimal treatment for IgG and IgA monoclonal gammopathy of uncertain signi cance neuropathies is not known.
Objectives
The objective of this review is to examine the ef cacy of any treatment for IgG or IgA paraproteinaemic peripheral neuropathy.
Search strategy
We performed searches of the Cochrane Neuromuscular Disease Group Trials register (May 2005), MEDLINE (from January 1966
to May 2005), EMBASE (from January 1980 to May 2005). We also checked bibliographies for controlled trials of treatments for IgG
or IgA paraproteinaemic peripheral neuropathy.
Selection criteria
We included randomised and quasi-randomised controlled trials using any treatment for IgG or IgA paraproteinaemic peripheral
neuropathy. People with IgM paraproteins were excluded.We excluded participants where the monoclonal gammopathy was considered secondary to an underlying disorder. We included participants of any age with a diagnosis of monoclonal gammopathy of uncertain significance with a paraprotein of the IgG or IgA class and a neuropathy. Included participants were not required to fulfil specific lectrophysiological diagnostic criteria.
Data collection and analysis
The full texts of potentially relevant studies were obtained and assessed and independent data extraction was performed by three authors.
Additional data and clarification were received from one author.
Main results
We identified only one randomised controlled trial with 18 participants which ful lled the predetermined inclusion criteria. Four other trials were identified but these were not randomised controlled trials. The included trial revealed a modest short-term benefit of plasma
exchange in IgG or IgA paraproteinaemic neuropathy, over a short follow-up period, when compared to sham plasma exchange.
Authors' conclusions
The evidence from randomised controlled trials for the treatment of IgG or IgA paraproteinaemic neuropathy is currently inadequate.
More randomised controlled trials of treatments are required. These should have adequate follow-up periods and contain larger numbers of participants, perhaps through multicentre collaboration, considering the relative infrequency of this condition. Observational or open
trial data provide limited support for the use of treatments such as plasma exchange, cyclophosphamide combined with prednisolone,intravenous immunoglobulin and corticosteroids. These show potential therapeutic promise but the potential benefits must be weighed against adverse effects. Their optimal use and the long-term benefits need to be considered and validated with well-designed randomised
controlled trials.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
*Immunoglobulin A; *Immunoglobulin G; Humans; Monoclonal gammopathies, benign [*therapy]; Peripheral nervous system diseases [*therapy]; Plasma exchange
Elenco autori:
D. Allen, M.P.T. Lunn, J. Niermeijer, E. Nobile-Orazio
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