Treatment of chronic immune-mediated neuropathies : Impact of the Rare Diseases Centers network in Italy

Chronic immune-mediated neuropathies represent a heterogeneous group of mostly demyelinating neuropathies thought to be caused by an autoimmune response to peripheral nerve antigens. They include chronic infl ammatory demyelinating polyradiculoneuropathy (CIDP) and related variants, multifocal motor neuropathy (MMN) and neuropathy associated with an IgM monoclonal gammopathy with antibody activity against myelin-associated glycoprotein (MAG). Most of these neuropathies respond to immune therapy even though their response to therapy may be different, thereby confi rming that their distinct characteristics have relevant clinical implications. While clinicians and scientists are intrigued by the desire to better clarify the cause and pathogenesis of these disorders, the need to allow affected patients to be reimbursed by insurance companies or the national health system can lead to the risk of lumping all these neuropathies under the umbrella term of CIDP to facilitate patientsaccess to costly therapies.