Drug therapy for chronic idiopathic axonal polyneuropathy

What is the aim of this review?

The aim of this Cochrane Review was to assess the benefits and harms of drug therapy for chronic idiopathic axonal polyneuropathy (CIAP).

Cochrane Review authors collected and aimed to analyse all relevant studies to answer this question. This is the most recent update of a review first published in 2004.

Key messages

There have not been any randomised trials of drug therapy for CIAP. Future trials will need sensitive outcome measures and long follow-up periods.

What was studied in the review?

CIAP is a frequent disorder in elderly people that can reduce quality of life. Typically, the feet, lower legs and sometimes the hands slowly become numb or weak. The need for evidence-based treatments is increasing as the number of people affected is likely to rise in ageing populations. By definition, the cause of CIAP is unknown.

What are the main results of the review?

We found no trials suitable for review.

How up to date is this review?

The evidence is up to date to July 2016.

Authors' conclusions: 

Even though CIAP has been clearly described and delineated, no adequate randomised or quasi-randomised controlled clinical treatment trials have been performed. In their absence there is no proven efficacious drug therapy.

Read the full abstract...
Background: 

Chronic idiopathic axonal polyneuropathy (CIAP) is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, CIAP reduces quality of life. CIAP is diagnosed in 10% to 25% of people referred for evaluation of polyneuropathy. There is a need to gather and review emerging evidence on treatments, as the number of people affected is likely to increase in ageing populations. This is an update of a review first published in 2004 and previously updated in 2006, 2008, 2011 and 2013.

Objectives: 

To assess the effects of drug therapy for chronic idiopathic axonal polyneuropathy for reducing disability and ameliorating neurological symptoms and associated impairments, and to assess any adverse effects of treatment.

Search strategy: 

In July 2016, we searched Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews in the Cochrane Library, MEDLINE, Embase, and the Web of Science. We searched two trials registries for ongoing trials. We also handsearched the reference lists of relevant articles, reviews and textbooks identified electronically, and we would have contacted authors and other experts in the field to identify additional studies if this seemed useful.

Selection criteria: 

We sought all randomised or quasi-randomised (alternate or other systematic treatment allocation) trials that examined the effects of any drug therapy in people with CIAP at least one year after the onset of treatment. People with CIAP had to fulfil the following criteria: age 40 years or older, distal sensory or sensorimotor polyneuropathy, absence of systemic or other neurological disease, chronic clinical course not reaching a nadir in less than two months, exclusion of any recognised cause of the polyneuropathy by medical history taking, clinical or laboratory investigations, and electrophysiological studies in agreement with axonal polyneuropathy, without evidence of demyelinating features. The primary outcome was the proportion of participants with a significant improvement in disability. Secondary outcomes were change in the mean disability score, change in the proportion of participants who make use of walking aids, change in the mean Medical Research Council sum score, degree of pain relief and/or reduction of other positive sensory symptoms, change in the proportion of participants with pain or other positive sensory symptoms, and frequency of adverse effects.

Data collection and analysis: 

Two review authors independently reviewed the results of the literature search and extracted details of trial methodology and outcome data of all potentially relevant trials.

Main results: 

We identified 39 studies and assessed them for possible inclusion in the review, but we excluded all of them because of insufficient quality or lack of relevance. We summarised evidence from non-randomised studies in the Discussion.

Share/Save