Can CIDP Be Reversed? A Closer Look at the Evidence

Though CIDP is treatable and some symptoms can be reversed, complete recovery is rare.  

 

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CIDP (chronic inflammatory demyelinating polyneuropathy) is a rare autoimmune disorder. In people with CIDP, the immune system damages the peripheral nerves (nerves outside the brain and spinal cord). 

This condition affects about 30,000 Americans [1]. Primary treatments include corticosteroids, plasmapheresis (plasma exchange-PE), and IVIG. They aim to:

• Improve symptoms
• Restore functionality
• Achieve long-lasting remission (a period during which the symptoms become less severe or disappear)

 

Factors That Determine If CIDP or Its Symptoms Can Be Reversed

Type of CIDP

The three main types of CIDP are listed below.

1. Monophasic: A single bout of CIDP persisting for several months or even years, followed by a period of spontaneous recovery. 
2. Chronic relapsing: The symptoms continue to worsen, followed by remissions between relapses. 
3. Chronic progressive: The symptoms worsen constantly and never improve. 

Age at Diagnosis

In general, younger age at diagnosis is a good predictor of a more favorable long-term prognosis. 

Symptom Type

People with symmetrical symptoms—weakness and numbness on both sides of the body—tend to have fewer relapses and better treatment outcomes [3].

The Amount of Time Symptoms Take To Worsen 

In general, the longer it takes for the symptoms to worsen, the better the long-term prognosis. 

Early Response to Treatment

A good initial response to treatment is suggestive of prolonged remission. 

Treatment Initiation

The earlier the treatment starts following diagnosis, the lower the chance of permanent nerve damage. 

 

Can CIDP Be Reversed? Recovery Is Possible But Rare

Only a handful of studies suggest CIDP can be reversed. However, early and appropriate treatments have resulted in prolonged remission. 

For instance, a 2017 trial revealed that maintenance treatment with 1g/kg IVIG every 21 days resulted in sustained remission for 52 weeks in about 70% of the participants [4].

In 2018, Japanese researchers published a case report showing the restoration of nerve function in a woman. The woman received steroids at age 54, and her nerve function improved at 68, 72, and 73 years of age [5].

In a 2022 case report, a man with CIDP and MS reported full recovery of almost all symptoms following treatment with ocrelizumab [6]. Notably, the person was resistant to conventional treatments for both CIDP and MS. 

Health experts are investigating other treatment options, such as hematopoietic stem cell transplantation (HSCT), also known as bone marrow transplant. It involves administering healthy blood-forming stem cells to a person with depleted bone marrow. Anecdotal evidence suggests that HSCT may reverse CIDP in some people. However, more extensive, well-controlled studies are needed to confirm this. 

A 2023 review concludes that HSCT can be effective in treatment-resistant CIDP [7]. So far, over 70 individuals with treatment-resistant CIDP have received HSCT [8].

 

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Does CIDP Affect Life Expectancy?

CIDP, on its own, is unlikely to affect lifespan. However, complications, coexisting medical conditions, and treatments can affect life expectancy and quality of life. 

A 2023 review suggests that nearly 1 in 2 individuals with CIDP have a favorable outcome and no disease-related disability [9].

 

Can CIDP Go Away on Its Own?

Spontaneous recovery is possible in some cases. This is a common feature of the monophasic category of CIDP. Nonetheless, early diagnosis and treatment are crucial to prevent permanent nerve damage. 

 

Has Anyone Ever Recovered From CIDP?

Although possible, complete recovery is rare. Even among individuals who recover entirely, numbness and weakness may persist indefinitely. 

 

What Is the Most Effective Treatment for CIDP?

• Corticosteroids
• Plasma exchange
• IVIG
• Immunotherapies
• Monoclonal antibodies

 

 

REFERENCES:

1. School, McGovern Medical. “CIDP | Chronic Inflammatory Demyelinating | UTHealth Houston.” Neurology, Neurosurgery, Spine Care | UTHealth Neurosciences, 17 Oct. 2023, med.uth.edu/neurosciences/conditions-and-treatments/nerve-disorders/chronic-inflammatory-demyelinating-polyneuropathy.
2. Brun, S.; de Sèze, J.; Muller, S. CIDP: Current Treatments and Identification of Targets for Future Specific Therapeutic Intervention. Immuno 2022, 2, 118-131. https://doi.org/10.3390/immuno2010009
3. Kuwabara, S et al. “Long term prognosis of chronic inflammatory demyelinating polyneuropathy: a five year follow up of 38 cases.” Journal of neurology, neurosurgery, and psychiatry vol. 77,1 (2006): 66-70. doi:10.1136/jnnp.2005.065441
4. Kuwabara, Satoshi, et al. “Intravenous Immunoglobulin for Maintenance Treatment of Chronic Inflammatory Demyelinating Polyneuropathy: A Multicentre, Open-label, 52-week Phase III Trial.” Journal of Neurology, Neurosurgery, and Psychiatry, vol. 88, no. 10, Aug. 2017, pp. 832–38. https://doi.org/10.1136/jnnp-2017-316427.
5. Koike, Haruki et al. “Restoration of a Conduction Block after the Long-term Treatment of CIDP with Anti-neurofascin 155 Antibodies: Follow-up of a Case over 23 Years.” Internal medicine (Tokyo, Japan) vol. 57,14 (2018): 2061-2066. doi:10.2169/internalmedicine.0455-17
6. Auer, Michael et al. “Recovery of Chronic Inflammatory Demyelinating Polyneuropathy on Treatment With Ocrelizumab in a Patient With Co-Existing Multiple Sclerosis.” Journal of central nervous system disease vol. 14 11795735221084837. 28 Mar. 2022, doi:10.1177/11795735221084837
7. Zheng, Yongsheng et al. “Efficacy of hematopoietic stem cell transplantation treatment in refractory chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis.” European journal of neurology vol. 30,8 (2023): 2570-2582. doi:10.1111/ene.15857
8. Qin, Zhen et al. “Progress in Hematopoietic Stem Cell Transplantation for CIDP.” International journal of medical sciences vol. 17,2 234-241. 14 Jan. 2020, doi:10.7150/ijms.38363
9. Al-Zuhairy, A., & Jakobsen, J. (2023). Outcome in chronic inflammatory demyelinating polyneuropathy: A systematic review and meta-analysis. Muscle & Nerve, 68(4), 388-396. https://doi.org/10.1002/mus.27820

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