Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a long-lasting disease where the body’s own immune system attacks the covering of the nerves (myelin) in the arms, legs and nerve roots near the spine. This damage slows or blocks the electrical signals in the nerves and causes weakness, numbness and other problems that usually get worse over at least 8 weeks.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a long-lasting autoimmune disease where the immune system attacks the myelin (insulation) around the peripheral nerves in the arms, legs and nerve roots. This damage slows or blocks nerve signals and causes weakness, numbness, tingling and sometimes pain, usually over at least 8 weeks. First-line medical treatments are usually corticosteroids, intravenous immunoglobulin (IVIG), subcutaneous immunoglobulin (SCIG) and plasma exchange, sometimes followed by other immune-suppressing medicines.
The word “chronic” means the problem lasts for a long time, not just a few days or weeks. “Inflammatory” means the immune system is active and causes swelling and damage. “Demyelinating” means the myelin (fatty insulation around nerves) is broken down. “Polyradiculoneuropathy” means many nerve roots (radiculi) and peripheral nerves (neuropathy) are involved.
CIDP is closely related to another disease called Guillain-Barré syndrome (GBS). GBS usually starts suddenly and is short-term (acute), while CIDP comes on more slowly and keeps going or comes back in attacks, so it is called the “chronic” form.
Other names
Doctors use several different names for this condition. The most common short name is CIDP, which stands for chronic inflammatory demyelinating polyneuropathy (or polyradiculoneuropathy). Other names include chronic relapsing polyneuropathy and chronic inflammatory demyelinating polyradiculoneuropathy (the longer form that shows the nerve roots are also affected). All these names describe the same main disease.
Types
Experts now know that CIDP is not just one pattern. There is a “typical” form and several “atypical” (special) forms or variants.
- Typical CIDP is the most common type. It causes weakness and numbness that are fairly symmetric (similar on both sides) and involve both the muscles close to the body (hips, shoulders) and far away (hands, feet). Reflexes (like the knee jerk) are usually reduced or lost.
- Progressive CIDP means the symptoms slowly get worse over months or years without clear breaks. People may notice they can walk shorter distances every year or find daily tasks harder and harder.
- Recurrent (relapsing) CIDP means symptoms improve for a while and then come back again in attacks or relapses. There may be weeks or months between relapses, and each relapse can cause new weakness or numbness.
- Monophasic CIDP means there is one long episode that lasts about 1–3 years and then does not return. The person may still have some remaining weakness or numbness, but there are no new attacks.
- Distal acquired demyelinating symmetric neuropathy (DADS) is an atypical form where symptoms mainly start in the feet and hands (distal parts), often with more sensory problems than weakness. It is sometimes linked with an abnormal protein in the blood (IgM paraprotein).
- Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM or Lewis–Sumner syndrome) is another atypical form. It often causes patchy weakness and numbness in one arm or one leg more than the other, instead of being fully symmetric.
- Pure motor CIDP is a rare form where weakness is the main problem and sensation stays almost normal. Electrodiagnostic tests show demyelination in motor (movement) nerves but much less in sensory nerves.
- Pure sensory CIDP is the opposite pattern. Here, numbness, tingling and balance problems are very strong, while muscle strength can be almost normal. Some patients have demyelination mainly in sensory roots and nerves.
Causes and associated factors
For most people with CIDP, the exact cause is unknown. Doctors think it is an autoimmune disease, where the immune system wrongly attacks myelin in peripheral nerves and roots.
Primary autoimmune attack on myelin – The main cause is thought to be a mis-directed immune response against proteins in myelin or at the node of Ranvier (a key part of the nerve fiber). This immune attack leads to inflammation, demyelination and sometimes loss of nerve fibers.
Abnormal T-cell and B-cell activity – Studies show over-active immune cells (T cells and B cells) and autoantibodies in many patients. These cells and antibodies can directly damage myelin or call in other inflammatory cells that do the damage.
Molecular mimicry after infection – In some people, an infection may “look like” myelin to the immune system. The body then makes antibodies against the infection that also attack myelin, a process called molecular mimicry.
Previous respiratory or stomach infection – Several studies found that a number of patients had a flu-like illness, sore throat, or stomach infection in the weeks before the first nerve symptoms. This suggests infection can be a trigger in some cases.
Diabetes mellitus (possible risk) – Diabetes damages nerves by itself, but some research suggests people with diabetes may also develop immune-mediated demyelinating neuropathy that behaves like CIDP. The link is still debated and may not be strong in everyone.
Monoclonal gammopathy (MGUS) and abnormal antibodies – Some patients have an abnormal clone of plasma cells that produces a monoclonal antibody. This antibody can bind to nerve structures and contribute to demyelination, creating a CIDP-like neuropathy.
Blood cancers (lymphoma, myeloma) – Certain lymphomas and multiple myeloma can be associated with demyelinating neuropathies that meet criteria for CIDP. The cancer and the abnormal antibodies it produces may both trigger nerve inflammation.
HIV infection – CIDP-like neuropathy can appear at different stages of HIV. Immune changes and chronic infection both may help start or maintain the autoimmune attack on nerves.
Hepatitis B or C infection – Long-term hepatitis B or C can cause immune system activation, cryoglobulinemia and vasculitis, and these can be linked with demyelinating neuropathies similar to CIDP in some people.
Connective tissue diseases (such as lupus or Sjögren syndrome) – Systemic autoimmune diseases can attack many organs, including peripheral nerves. In some patients, the pattern of nerve damage looks like CIDP even though another autoimmune disease is present.
Inflammatory bowel disease – Conditions like Crohn’s disease and ulcerative colitis cause chronic immune activation in the gut. In rare cases, people with these diseases also develop an acquired demyelinating neuropathy similar to CIDP.
Other chronic inflammatory disorders (such as sarcoidosis) – Chronic inflammatory diseases outside the nervous system can sometimes be linked to immune-mediated neuropathies, including CIDP-like patterns. The inflammation in the body may “spill over” to the nerves.
Paraproteinemic and POEMS-related neuropathies – Some rare syndromes with abnormal proteins, bone lesions and hormone problems (like POEMS syndrome) have chronic demyelinating neuropathies that overlap with CIDP in their features.
Genetic and immune susceptibility – There is no single “CIDP gene”, but studies suggest that some people may have immune system genes that make an autoimmune reaction more likely when they meet a trigger such as an infection.
Pregnancy and hormonal changes (rare trigger) – A few reports describe relapses of CIDP during pregnancy or soon after delivery, suggesting that changing hormones and immune shifts might unmask or worsen the disease in some women.
Vaccinations (very rare, possible trigger) – There are occasional reports of CIDP starting after vaccines, similar to GBS. However, this appears to be extremely rare, and vaccines remain very important for preventing serious infections.
Chronic low-grade infections (bacteria or viruses) – Long-lasting infections can keep the immune system active. In some patients, this may help maintain an autoimmune attack on nerves, although a clear cause–effect link is hard to prove.
Other autoimmune neuropathies and overlap syndromes – CIDP may overlap with other immune neuropathies, such as those with specific antibodies against nodal or paranodal proteins (like neurofascin-155). These are special subgroups with slightly different behavior and treatment response.
Drugs that affect the immune system (possible contributor) – In rare cases, medicines that strongly change immune function may be linked to acquired demyelinating neuropathy. In many such patients it is hard to know if the drug or the underlying disease is the main cause.
Truly idiopathic (no clear cause found) – Even after careful testing, many people with CIDP have no infection, no cancer and no other autoimmune disease. In these “idiopathic” cases, the immune system attack on nerves is real, but the original trigger stays unknown.
Symptoms and signs
CIDP usually develops slowly over at least 8 weeks. Symptoms may keep getting worse or may come and go in attacks.
Gradual weakness in the legs – Many people first notice that their legs feel heavy or tired. They may have trouble climbing stairs, rising from a chair or walking long distances because the muscles close to the hips become weak.
Weakness in the arms – As the disease progresses, the arms can also become weak. Holding objects, lifting things to shelves or keeping arms raised for a long time may become difficult.
Numbness in feet and hands – Loss of normal feeling (sensation) is common. At first, people often feel numbness in the toes and soles of the feet, then later in the fingers and hands.
Tingling or “pins and needles” – Tingling, buzzing or electric-like feelings in the feet and hands (called paresthesias) are very typical. These feelings can be annoying or even painful.
Poor balance and unsteady walking – Damage to sensory fibers that carry vibration and position information makes it hard for the brain to know where the feet are. People may sway, stumble, or need support, especially in the dark.
Loss of reflexes – When the doctor checks reflexes with a hammer, the knee-jerk and ankle reflexes are often reduced or absent. This loss of reflexes is a key sign of CIDP.
Neuropathic pain – Some people have burning, shooting, or aching pain in the feet, legs, hands or arms. This pain comes from damaged nerves sending abnormal signals to the brain.
Muscle cramps and spasms – Irritated nerves can cause muscles to cramp or twitch. These cramps may be worse at night and can disturb sleep or daily activities.
Fatigue and easy tiredness – Walking or doing tasks with weak and partially denervated muscles uses more energy. Many patients feel very tired, even with simple activities.
Difficulty with fine hand movements – Tasks like buttoning clothes, writing, using keys or typing may become clumsy as small hand muscles weaken and sensation worsens.
Gait changes and frequent falls – People may walk with a wide-based, unsteady gait or lift their feet higher than normal to avoid tripping. Falls can happen because of weakness and poor balance together.
Tremor or shaking – A postural tremor (shaking when holding a position) can appear in the hands, probably because of sensory loss and impaired feedback from the nerves to the muscles.
Autonomic symptoms (sometimes) – Some patients report dizziness when standing up, changes in sweating or bladder problems. These symptoms mean that autonomic nerves may also be involved, although this is less common.
Cranial nerve involvement (rare) – In a small number of patients, nerves to the face or eyes can be affected, causing double vision, facial weakness or trouble swallowing, but this is much less common than limb symptoms.
Relapsing or fluctuating pattern – In relapsing forms, symptoms may improve with treatment or on their own, then worsen again. This “up and down” course over many months is typical for some people with CIDP.
Diagnostic tests
Doctors use a mix of clinical examination, manual bedside tests, laboratory and pathological tests, electrodiagnostic tests, and imaging tests to diagnose CIDP and to rule out other diseases. No single test is perfect, so the diagnosis is based on the whole picture plus guideline criteria.
Physical exam tests
Full neurological history and examination – The doctor listens to the story (time course, pattern of weakness, numbness, relapses) and then checks strength, sensation, reflexes and coordination. A slowly progressive or relapsing symmetric neuropathy lasting more than 8 weeks strongly suggests CIDP.
Muscle strength testing – Each major muscle group in arms and legs is tested against resistance and graded, usually with a simple scale (for example, 0–5). In CIDP there is often weakness in both proximal (hip, shoulder) and distal (hands, feet) muscles.
Reflex testing (deep tendon reflexes) – Reflexes are tested with a small hammer at the knees, ankles, elbows and wrists. In CIDP, these reflexes are frequently reduced or absent in several limbs, which is an important diagnostic clue.
Sensory examination – The doctor checks light touch, pinprick, vibration and joint position sense in the toes, fingers and other areas. In CIDP, vibration and position sense are often more affected than pain and temperature, leading to sensory ataxia.
Gait and balance assessment – The patient is asked to walk in a straight line, walk on heels and toes, and to stand with feet together and eyes closed (Romberg test). In CIDP, gait may be broad-based and unsteady, and balance often worsens when the eyes are closed.
Manual bedside tests
Manual muscle testing with grading – The examiner uses their hands to test how strongly the patient can push or pull in different directions, giving a detailed map of which muscles are weak. This helps separate CIDP from diseases that mainly affect only distal muscles.
Tuning fork vibration test – A vibrating tuning fork is placed on bony points like the big toe, ankle or wrist. In CIDP, the person often feels the vibration less strongly or not at all, showing loss of large-fiber sensory function.
Monofilament or light-touch testing – A thin plastic filament or cotton is used to test light touch on the feet and hands. Reduced or absent feeling supports peripheral nerve involvement, and patterns of loss can help distinguish CIDP from other neuropathies.
Timed walking or stair-climb tests – Simple timed tests (for example, how long it takes to walk 10 meters or climb a flight of stairs) give an objective measure of leg function and can be repeated over time to track progression or response to treatment.
Laboratory and pathological tests
Basic blood tests (CBC, ESR/CRP, kidney and liver function) – These tests help rule out infections, anemia, severe inflammation and organ failure that might cause other types of neuropathy or complicate treatment decisions in people with CIDP.
Blood glucose and HbA1c – Measuring blood sugar and long-term glucose control helps detect diabetes, which can also cause neuropathy. This is important to separate diabetic neuropathy from CIDP or to recognize when both are present together.
Vitamin B12, folate and thyroid hormone levels – Deficiency of vitamin B12, low folate, or abnormal thyroid function can cause neuropathy that may look similar to CIDP. Checking these helps to rule out or treat these other causes.
Serum protein electrophoresis and immunofixation – These blood tests look for monoclonal proteins (paraproteins) and can detect MGUS, myeloma or related conditions that may be linked to demyelinating neuropathies or CIDP variants like DADS.
Autoimmune screen (such as ANA and related tests) – These tests check for markers of systemic autoimmune diseases like lupus or Sjögren syndrome. Finding such markers can show that the neuropathy is part of a broader autoimmune illness.
Infection screening (HIV, hepatitis B and C) – Specific blood tests can find chronic infections that are sometimes associated with CIDP-like neuropathies. Identifying these infections helps direct treatment and better understand the cause of the neuropathy.
Cerebrospinal fluid (CSF) analysis by lumbar puncture – A needle is used to collect fluid from around the spinal cord. In many CIDP patients the protein level is high but the cell count is normal (“albuminocytologic dissociation”), which supports the diagnosis, though it is not present in all cases.
Nerve biopsy (often sural nerve) – In unclear or atypical cases, a small piece of a sensory nerve, such as the sural nerve in the leg, may be removed and examined under the microscope. Thickened myelin, demyelination and inflammation can support a diagnosis of CIDP or related variants.
Electrodiagnostic tests
Nerve conduction studies (NCS) – Small electrical pulses are given to a nerve and the responses are measured. In CIDP, NCS often show slowed conduction velocity, prolonged distal latencies, conduction block and temporal dispersion, all signs of demyelination that are central to diagnostic criteria.
Electromyography (EMG) – A thin needle electrode is placed into muscles to record electrical activity. EMG can show signs of chronic denervation and re-innervation, helping to judge the severity of nerve damage and to exclude muscle diseases that might mimic CIDP.
Somatosensory evoked potentials (SSEPs) – Small electrical or sensory stimuli are given to a nerve, and the responses are recorded over the spine or brain. Delayed or altered responses in SSEPs can provide additional evidence of demyelination in sensory pathways, especially when NCS findings are borderline.
Non-pharmacological treatments
Individualized physiotherapy program
A regular, gentle physiotherapy program helps keep muscles strong and joints flexible when nerve signals are weak. Strength, stretching, posture and balance exercises are chosen according to how severe the weakness is. The goal is to improve walking, reduce stiffness and prevent contractures (permanent joint tightening). Physiotherapy is usually started early and then adjusted over time as medical treatments begin to control inflammation, so that function improves as safely as possible.Occupational therapy for daily activities
Occupational therapists teach easier and safer ways to perform dressing, bathing, cooking and working with weak hands and legs. They may suggest energy-saving strategies, pacing, and different ways to organize the home. They also help with hand function and fine movements such as writing or using a keyboard, using adaptive tools when needed. The purpose is to keep the person as independent as possible despite nerve damage.Assistive devices (canes, walkers, wheelchairs)
Assistive devices such as canes, walkers or wheelchairs can be temporary or long-term supports. They reduce the risk of falls, conserve energy and allow people with CIDP to move more safely in the home and community. The specific device is chosen after a professional gait and balance assessment. Using a device is not a “failure” but a tool to stay active and protect joints and bones while the immune treatments work.Ankle–foot orthoses and splints
If the feet drop or toes drag because of weakness, ankle–foot orthoses (AFOs) can hold the foot in a safer position. Wrist or hand splints may support weak grip and prevent contractures. These braces are custom fitted by orthotists and checked regularly as muscle strength changes. Their main purpose is to improve walking, standing and hand function and to prevent deformity over time.Balance and gait training
Many people with CIDP feel unsteady because their nerves do not send clear position signals to the brain. Special balance exercises, such as standing on different surfaces, turning, and walking with head movements, retrain the nervous system. Gait training may include practicing step length, foot placement and turning. This kind of targeted training can reduce falls and increase confidence in walking.Pain psychology and cognitive-behavioural therapy (CBT)
Chronic neuropathic pain can make sleep, mood and coping much harder. CBT and pain-focused psychological therapies teach skills such as relaxation, thought reframing, goal setting and pacing. These help the brain handle pain signals more calmly and reduce the emotional distress connected to pain, even when some pain is still present.Transcutaneous electrical nerve stimulation (TENS)
TENS uses small electrical pulses delivered through pads on the skin to change how pain signals travel to the brain. For some people with neuropathic pain, regular TENS sessions reduce burning or tingling sensations. It is usually used together with medications, not instead of them, and the settings are adjusted under guidance so the stimulation is comfortable and safe.Hydrotherapy and pool-based exercise
Warm-water exercises allow people with weakness or balance problems to move more freely because water supports body weight. Walking, gentle strengthening and stretching in a pool can improve fitness with less stress on joints. Hydrotherapy can also relax painful muscles. It must be supervised at first, especially if there is severe weakness or fatigue.Energy-conservation and fatigue-management training
CIDP often causes fatigue, both from the disease and from working harder to move weak muscles. Therapists teach pacing, planning activities, taking planned breaks, sitting instead of standing where possible, and prioritizing important tasks. Good fatigue management prevents “boom and bust” cycles, where overactivity on good days is followed by severe exhaustion.Sleep hygiene interventions
Good sleep is important for nerve healing and for coping with chronic disease. Sleep hygiene means keeping a regular sleep–wake schedule, avoiding caffeine late in the day, creating a cool and dark bedroom, and limiting screens before bed. When pain or tingling disrupt sleep, combining sleep hygiene with medical pain control can improve rest and daytime function.Psychological counselling and emotional support
Living with a long-term nerve disease can cause worry, sadness, or even depression. Counselling offers a safe place to talk, learn coping strategies, and adjust to changes in work and family roles. Support can be individual, family-based, or group-based. This emotional care is as important as physical treatment, because mood strongly affects recovery and quality of life.Peer support and patient groups
Support groups (in person or online) connect people who have CIDP or other neuropathies. Members share experiences about treatments, rehabilitation and daily living. Hearing from others who understand the condition can reduce feelings of isolation and fear, and can also help people learn about available services and rights.Workplace and school adaptations
For students or workers with CIDP, simple changes can make a big difference. Examples include flexible hours, the option to work from home, ergonomic chairs and keyboards, or closer parking spaces. Occupational health services can guide these adjustments. The purpose is to keep people engaged in education or work, which supports mental health and financial stability.Home safety modifications
Occupational therapists may recommend grab bars, non-slip mats, handrails on stairs, better lighting, raised toilet seats or rearranged furniture. These changes reduce tripping and falling, especially when sensation in the feet is poor. Simple home-safety checks are an easy, low-cost part of CIDP care that can prevent serious injuries.Weight management and gentle aerobic exercise
Excess weight makes walking and transfers harder and increases strain on joints. Low-impact aerobic activities such as stationary cycling, water walking, or short walks help maintain heart health and manage weight. Exercise programs must be tailored to avoid over-fatigue; the goal is “little and often” activity rather than intense workouts.Smoking cessation support
Stopping smoking improves blood flow to nerves, reduces overall inflammation and lowers the risk of heart and lung disease. Counselling, nicotine replacement and behaviour programs can help. For someone with CIDP, quitting smoking supports better long-term nerve and general health, even though it does not directly cure the autoimmune attack.Alcohol-reduction counseling
Too much alcohol is toxic to nerves and can worsen neuropathy. Reducing or stopping alcohol helps protect remaining nerve function and prevents extra damage on top of CIDP. Counselling, support groups and medical help can all be used to support change.Nutrition counselling for anti-inflammatory eating
Dietitians can help design an eating plan rich in vegetables, fruits, whole grains, healthy fats and lean proteins. This kind of “anti-inflammatory” pattern supports general health, weight, gut function and blood sugar control. While food alone cannot treat CIDP, good nutrition is a simple tool to support the body’s healing processes.Education and self-management training
Learning about CIDP, its symptoms, tests, and treatment options helps patients make informed choices. Education includes how to monitor symptoms, when to call the doctor, and how to prepare for visits. Good self-management reduces fear and improves cooperation with long-term treatment plans.Vaccination planning and infection-prevention habits
Because infections may trigger relapses or complicate treatment, doctors often recommend up-to-date routine vaccinations (for example flu and pneumonia, following national guidelines) and good hygiene habits. Hand-washing, prompt treatment of infections and avoiding contact with sick people can help protect health, especially when the immune system is being suppressed by drugs.
Drug treatments
Here we focus on drugs that are commonly used or approved for CIDP. Main approvals and dosing information come from FDA labels and major treatment reviews.
Intravenous immunoglobulin (IVIG – class: immune globulin 10%)
IVIG is a purified antibody product from pooled human plasma. It calms the immune system by blocking harmful antibodies and modulating immune cells. For CIDP, it is usually given as weight-based infusions every 3–6 weeks, using products such as Gamunex-C or Gammagard. Typical side effects include headache, flu-like symptoms, infusion reactions, and rarely kidney problems or aseptic meningitis, so monitoring during and after infusion is required.Subcutaneous immunoglobulin (SCIG – including HyQvia)
SCIG delivers similar immunoglobulin under the skin in smaller, more frequent doses, sometimes using products like HyQvia that combine IgG with hyaluronidase to allow larger volumes. For CIDP this is used mainly as maintenance therapy to prevent relapses after stabilization with IVIG. Common side effects include local redness or swelling and mild systemic symptoms. The dose and schedule are planned by the neurologist.Efgartigimod alfa and hyaluronidase (Vyvgart Hytrulo – class: FcRn blocker)
Vyvgart Hytrulo is a newer drug approved for adult CIDP. It blocks the neonatal Fc receptor (FcRn), which reduces the level of circulating IgG antibodies thought to drive the autoimmune attack. It is given as a once-weekly subcutaneous injection over 30–90 seconds. In trials it reduced relapse risk compared with placebo, with side effects such as respiratory infections, headaches and injection-site reactions. Serious allergic reactions are possible but uncommon, so monitoring is important.Prednisone (oral corticosteroid)
Prednisone is a steroid that strongly reduces inflammation and suppresses immune activity. In CIDP it may be started at a moderate or high daily dose and then slowly tapered over months if symptoms improve. It can improve strength but long-term use may cause weight gain, bone thinning, diabetes, high blood pressure, mood changes and infection risk, so doctors balance benefits and harms carefully and monitor closely.Intravenous methylprednisolone (IV pulse steroid)
High-dose methylprednisolone given intravenously in pulses (for example once weekly or over several days per month) can give faster immune suppression while sometimes limiting some side effects of daily tablets. It may be used as an alternative to oral steroids in some CIDP patients. Possible adverse effects include insomnia, mood swings, high blood sugar, stomach irritation, and bone loss with repeated courses.Plasma exchange (therapeutic plasma exchange – “drug-like” procedure)
Plasma exchange removes blood, separates the plasma that contains harmful antibodies and immune factors, and returns the blood cells with replacement fluid. For CIDP it can give fairly rapid improvement, but the effect may fade, so sessions are often repeated. Side effects include low blood pressure, bleeding risk and catheter-related problems. It is usually reserved for patients who do not respond well to IVIG or steroids, or who need quick improvement.Azathioprine (immunosuppressant)
Azathioprine is an oral drug that reduces lymphocyte activity by interfering with DNA synthesis. It is sometimes added to steroids or IVIG to allow lower doses over the long term. Benefits may take several months to appear. Side effects include nausea, liver irritation, bone-marrow suppression (low blood counts) and increased infection risk, so regular blood tests are required. Evidence for benefit in CIDP is limited, so its use is individualized.Mycophenolate mofetil (immunosuppressant)
Mycophenolate blocks an enzyme needed for lymphocyte proliferation. In CIDP it is used mainly as a “steroid-sparing” agent when patients need long-term immune control. It is taken orally twice daily. Possible adverse effects include gastrointestinal upset, low white blood cells and infection risk, and it must not be used in pregnancy because of birth-defect risk. Evidence is based mainly on observational studies rather than strong trials.Cyclosporine (calcineurin-inhibitor immunosuppressant)
Cyclosporine inhibits T-cell activation by blocking calcineurin. It may help some patients with difficult CIDP when first-line treatments fail, often in combination with steroids or IVIG. It is taken orally and needs regular monitoring of blood levels, kidney function and blood pressure. Side effects can include kidney damage, tremor, gum overgrowth and increased infection risk.Tacrolimus (calcineurin inhibitor)
Tacrolimus works in a way similar to cyclosporine, but is more potent on a per-milligram basis. Some case reports and small series suggest it may help certain refractory CIDP patients. It is used under specialist supervision with monitoring of trough levels, kidney function, blood pressure and blood sugar. Common side effects include tremor, headache, high blood sugar, and risk of infection.Cyclophosphamide (alkylating immunosuppressant)
Cyclophosphamide is a powerful chemotherapy-type drug that strongly suppresses immune cells. In very severe, treatment-resistant CIDP it may be used in short courses, sometimes as part of stem cell transplant conditioning. It can lead to serious side effects such as low blood counts, infertility risk, bladder irritation and increased cancer risk. Therefore it is reserved for selected patients after careful discussion of risks and benefits.Methotrexate (antimetabolite immunosuppressant)
Methotrexate blocks folate-dependent processes in dividing cells and is widely used in rheumatology. It has been studied in CIDP but randomized trials have not proven clear benefit; however, some clinicians still try it in individual patients as a steroid-sparing agent. It is usually given once weekly with folic acid supplementation. Side effects include liver toxicity, mouth ulcers, nausea, and bone-marrow suppression.Rituximab (anti-CD20 monoclonal antibody)
Rituximab targets CD20 on B cells and depletes them, lowering antibody production. It is not yet formally approved for CIDP, but has been used off-label for treatment-resistant cases and some related nodal or paranodal antibody neuropathies. It is given as intravenous infusions spaced weeks apart. Side effects include infusion reactions, low immunoglobulin levels over time and risk of serious infections, so use is restricted to specialist centres.Intravenous immunoglobulin 10% product “Privigen”
Privigen is one specific 10% IVIG product with an FDA indication for CIDP in adults. It is given as weight-based infusions on a regular schedule, similar to other IVIGs, with monitoring for infusion reactions, thrombosis risk and kidney function. As with other IVIGs, common adverse events include headache, chills and fatigue, usually during or shortly after infusion.Other IVIG brands (for example Gamunex-C, Gammagard)
Several IVIG brands are used for CIDP with similar dosing strategies but slightly different stabilizers and manufacturing processes. Labels warn about aseptic meningitis, thrombosis, kidney injury and hemolysis as rare but serious adverse effects, so doctors choose dose and infusion rate carefully and monitor high-risk patients closely.Interferon beta-1a (immunomodulatory biologic – limited evidence)
Interferon beta-1a modifies immune signalling and is widely used in multiple sclerosis. Trials in CIDP have not shown clear benefit, so it is rarely used. When tried, it is given as subcutaneous injections several times per week. Common side effects include flu-like symptoms, injection-site reactions and mood changes.Fingolimod (sphingosine-1-phosphate modulator – experimental)
Fingolimod traps lymphocytes in lymph nodes. A trial in CIDP did not show convincing benefit, and safety concerns (for example heart-rate changes and infection risk) limit its use in this setting. It is mentioned here mainly because it appears in the research literature but is not standard CIDP therapy.Mycophenolic acid delayed-release formulations
Some patients use delayed-release versions of mycophenolic acid instead of mycophenolate mofetil for similar immunosuppressive effects. The goal is better stomach tolerance while maintaining immune control. The same risks of low blood counts, infections and pregnancy harm remain, so close follow-up is needed.Oral pain medicines for neuropathic pain (for example duloxetine, gabapentin)
Although these drugs do not treat the autoimmune cause of CIDP, they can reduce burning, tingling and electric-shock pains. Common choices include duloxetine, gabapentin or pregabalin. Doses are increased slowly to balance pain relief with side effects such as drowsiness, dizziness or stomach upset. Good pain control improves sleep and participation in physiotherapy.Other immunosuppressive agents in selected cases
In rare, highly resistant cases, other agents such as sirolimus or combination regimens may be tried in specialist centres, based mainly on small case series. These are considered only after failure or intolerance of standard options and always include careful monitoring for infection, kidney, liver or metabolic complications.
Dietary molecular supplements
Always discuss supplements with your doctor or pharmacist to avoid interactions with prescription medicines.
Vitamin B12
Vitamin B12 is essential for healthy myelin and nerve function. Even mild deficiency can worsen neuropathy symptoms. In people with low or borderline levels, B12 replacement by tablets or injections may support nerve repair alongside other CIDP therapies. Typical replacement doses are decided by the doctor. Very high doses are usually well tolerated but can rarely cause acne-like rashes or upset stomach.Vitamin D
Vitamin D helps regulate immune function and bone health. Low vitamin D is common in chronic illness and may be linked to higher inflammation and weaker bones, especially in people taking long-term steroids. Supplementation to reach a normal blood level can support general health; doses vary by baseline level and should be guided by blood tests to avoid toxicity.Omega-3 fatty acids (fish oil)
Omega-3 fatty acids from fish oil have anti-inflammatory effects and may support heart and nerve health. In CIDP, they may slightly lower systemic inflammation and support cardiovascular protection, especially in less active people. Typical doses are in the range used for heart health, but high intakes can increase bleeding risk in some patients, so medical advice is important, particularly if other blood-thinning drugs are used.Alpha-lipoic acid
Alpha-lipoic acid is an antioxidant that has shown benefit in some diabetic neuropathy studies. It may help reduce oxidative stress and improve nerve blood flow. Some patients with CIDP take it hoping for extra nerve support, although direct evidence in CIDP is limited. Possible side effects are nausea, rash or low blood sugar in people with diabetes.Acetyl-L-carnitine
Acetyl-L-carnitine may support mitochondrial energy production in nerves and has been studied in certain neuropathies. It might help with fatigue and nerve regeneration, but strong evidence in CIDP is lacking. Doses vary and can cause mild gastrointestinal upset or restlessness in some people.Coenzyme Q10
Coenzyme Q10 is another mitochondrial cofactor involved in energy production. It is sometimes used to help with fatigue and muscle energy in chronic conditions. In CIDP, it may support overall energy levels, but again data are limited. Side effects are usually mild, such as stomach upset or headache at higher doses.Magnesium
Magnesium is important for nerve excitability and muscle relaxation. In people who are deficient, replacing magnesium may help reduce cramps and improve sleep quality. Too much can cause diarrhoea, and people with kidney disease must be cautious, so supplementation should be discussed with a clinician.Folate (vitamin B9)
Folate works with B12 in DNA synthesis and red blood cell production. Low folate can worsen anaemia and tiredness and may indirectly affect nerve health. Supplementation is helpful only if levels are low or dietary intake is poor. High doses can mask B12 deficiency, so combined testing and correction of both vitamins are important.Probiotics and prebiotic fibre
The gut microbiome interacts with the immune system. Probiotics and fibres that feed beneficial bacteria may support gut health and possibly reduce systemic inflammation. In CIDP, they are used to promote overall wellness, especially when drugs like steroids or immunosuppressants disturb gut function. Side effects are usually mild gas or bloating.Curcumin (turmeric extract)
Curcumin has anti-inflammatory and antioxidant properties in experimental studies. Some patients use standardized curcumin supplements to support joint comfort and general inflammation control. Absorption can be low unless combined with enhancers such as piperine. Potential side effects include stomach upset and interactions with blood-thinning medicines, so professional advice is needed.
Immunity-modulating and regenerative / stem-cell-related therapies
Autologous hematopoietic stem cell transplantation (AHSCT)
AHSCT collects the patient’s own stem cells, gives high-dose chemotherapy to “reset” the immune system, then returns the stem cells to rebuild bone marrow. In very severe, treatment-resistant autoimmune diseases, including rare CIDP cases, this approach may lead to long periods of remission. However, the risks are high: severe infections, infertility and even death. It is considered only in experienced centres and within strict criteria.Experimental mesenchymal stem cell therapies
Mesenchymal stem cells (for example from bone marrow or fat tissue) are being studied as ways to quiet harmful immune responses and support tissue repair. Early research in autoimmune diseases suggests possible benefit, but evidence in CIDP is still very limited and mostly experimental. These treatments should be accessed only through regulated clinical trials, not unproven private clinics.High-dose IVIG as an “immune reset”
In some severe CIDP cases, doctors use higher-dose IVIG regimens early on to quickly control inflammation and possibly switch off aggressive immune clones. While IVIG is already a standard treatment, this “immune reset” concept treats it as a strong, short-term push to change disease course. The risks are similar to standard IVIG but may be higher because of larger total doses, so monitoring is essential.Efgartigimod as targeted IgG-lowering therapy
Efgartigimod (Vyvgart Hytrulo) is not a stem cell product, but it represents a modern, targeted immune therapy that selectively lowers pathogenic IgG by blocking FcRn. This can be seen as a “precision” immunotherapy aimed at the autoantibody arm of the disease, with potential to change long-term treatment patterns by reducing dependence on IVIG in some patients.Neuro-trophic factor and remyelination-focused research drugs
Researchers are studying molecules that mimic or enhance natural nerve growth factors and remyelinating signals. These experimental drugs aim to protect axons and stimulate new myelin formation. As of now, none are approved specifically for CIDP, but they represent an important future direction, especially for patients who continue to worsen despite good immune control.Gene- and cell-based therapies in clinical trials
Some early-stage trials explore gene-editing or other advanced cell therapies to treat immune-mediated or inherited neuropathies. For CIDP, such approaches remain theoretical or very early in development. They highlight the growing interest in long-term regenerative solutions but should be considered experimental and only accessed through ethical clinical studies.
Surgical options
Tendon-lengthening for severe contractures
If long-standing weakness and spasticity lead to fixed contractures in ankles or other joints, orthopaedic surgeons may perform tendon-lengthening procedures. These surgeries aim to improve joint position, make bracing easier and reduce pain. They are considered only after long-term physiotherapy has not helped enough.Orthopaedic correction of foot deformities
Foot deformities such as high arches or claw toes may develop from muscle imbalance. Corrective surgeries can realign bones and tendons to improve weight-bearing and reduce skin breakdown. The goal is to improve comfort and walking with braces, not to treat the underlying immune disease.Carpal tunnel or nerve-decompression surgery
Some CIDP patients also have nerve entrapment syndromes, such as carpal tunnel. When nerve tests and symptoms clearly show entrapment in addition to CIDP, decompression surgery may relieve local numbness or pain. It is important that neurologists and surgeons work together to be sure surgery will truly help.Port or catheter placement for long-term infusions
People receiving frequent IVIG or plasma exchange sometimes need a long-term venous access device. Surgical placement of a port or central line can make repeated infusions easier but brings risks of infection or thrombosis. Careful hygiene and monitoring are essential.Procedures related to AHSCT or other advanced therapies
If a patient undergoes stem cell transplantation or similar advanced treatment, various supportive procedures (such as central lines, bone marrow harvest or biopsies) may be performed. These are part of the overall protocol rather than direct CIDP surgeries, and they are done only in specialized centres.
Prevention and risk-reduction
Keep vaccinations up to date according to national and specialist guidelines, especially flu and pneumonia vaccines, to reduce infections that might trigger relapses.
Avoid smoking and seek help to stop if needed, since smoking worsens blood flow and inflammation.
Limit alcohol intake to protect nerves and overall health.
Maintain a healthy weight through diet and gentle activity to ease the load on weak muscles and joints.
Manage other health problems such as diabetes, high blood pressure and high cholesterol, because they can add extra nerve and blood-vessel damage.
Work with your doctor to avoid or minimize medicines known to be toxic to peripheral nerves where alternatives exist.
Practice good hand hygiene, prompt infection treatment and sensible crowd avoidance during outbreaks.
Follow physiotherapy and exercise plans regularly to maintain strength and balance.
Use home safety measures (grab bars, good lighting, non-slip mats) to prevent falls and fractures.
Keep regular follow-up appointments with the neurologist so changes in strength or sensation are noticed early and treatment can be adjusted quickly.
When to see a doctor
You should see a doctor or your neurologist regularly for planned follow-up, and urgently if there are warning signs. Warning signs include new or quickly worsening weakness in the legs or arms, increasing difficulty climbing stairs, standing, walking, or using your hands for daily tasks, or a sudden rise in falls. Also seek urgent help for new difficulty breathing, speaking, or swallowing, new bladder or bowel control problems, severe chest pain, or sudden confusion or high fever while on immune-suppressing medicines. These may signal a relapse, treatment side effect, or a serious infection and need prompt medical assessment.
What to eat and what to avoid
Eat plenty of colourful vegetables and fruits – they provide antioxidants and fibre that support overall health and may help reduce inflammation.
Choose whole grains such as brown rice, oats and whole-wheat bread instead of refined grains, to support stable blood sugar and gut health.
Include lean protein from fish, poultry, beans, lentils and tofu to support muscle repair and immune function.
Use healthy fats like olive oil, nuts, seeds and avocados instead of trans fats or heavy animal fats. Omega-3-rich fish (such as salmon, sardines) can be particularly helpful.
Stay well hydrated with water and unsweetened drinks to support circulation and medication tolerance.
Limit highly processed foods high in salt, sugar and trans fats, as they may worsen inflammation and weight gain.
Avoid excessive sugary drinks and sweets, which can disrupt blood sugar and weight, particularly important if on steroids.
Limit alcohol to protect nerves and reduce medication interactions; some patients may be advised to avoid it completely.
Be cautious with herbal supplements that claim to “boost immunity”, as they may interfere with prescribed immune-suppressing drugs; always ask your doctor first.
If appetite is low, ask for a dietitian review to find nutrient-dense but easy-to-eat foods, such as smoothies, soups and soft proteins.
Frequently asked questions
Is CIDP the same as Guillain–Barré syndrome (GBS)?
No. GBS usually comes on quickly over days to weeks and then improves, while CIDP is chronic and progresses or relapses over at least 8 weeks. Both are autoimmune demyelinating neuropathies, but CIDP generally needs long-term treatment and follow-up.Can CIDP be cured?
Many people achieve long periods of remission where symptoms are stable or greatly improved, sometimes with reduced treatment. However, CIDP is usually considered a chronic condition. The goal is to calm the immune attack, protect nerves, and maintain function as much as possible.How long do I need IVIG or other treatments?
The length of treatment varies. Some people need several months, others require long-term maintenance. Doctors regularly test strength and function, adjust doses, and may try cautious dose reductions to see if the disease stays quiet.Will I end up in a wheelchair?
Some people with severe or long-standing CIDP do need wheelchairs, but many do not. Early diagnosis, effective immune treatment and regular rehabilitation make it much more likely that you will stay mobile, even if you need braces or walking aids.Can I work or study with CIDP?
Many people continue working or studying with adjustments such as flexible schedules, the option to sit more, or reduced lifting. Early open discussion with employers or schools and occupational-health teams can help create a realistic plan.Is exercise safe for CIDP?
Yes, when guided by your health team. Gentle, regular exercise can improve strength, stamina and mood. Over-exercising weak muscles can cause extra fatigue, so physiotherapists help design safe programs and adjust them as you improve.Are there special tests to monitor CIDP?
Yes. Doctors may repeat nerve-conduction studies, strength testing, functional scores (such as walking distance) and sometimes spinal fluid or imaging. These results, together with your symptoms, guide treatment changes.Can CIDP affect breathing or swallowing?
CIDP mainly affects limb nerves, but in severe cases, breathing or swallowing muscles can be involved. If you notice new shortness of breath, difficulty swallowing, or changes in voice, you should seek urgent medical review.Is pregnancy possible with CIDP?
Many people with CIDP have successful pregnancies, but treatment plans may need adjustments, especially for drugs that can harm a fetus. Planning pregnancy with your neurologist and obstetrician allows safe choices and close monitoring.Do vaccines make CIDP worse?
Most guidelines support routine vaccines for people with CIDP, especially when they take immune-suppressing drugs, because infections can be dangerous. A small number of autoimmune neuropathies may follow infections or, very rarely, vaccines, but the overall benefit of preventing serious infections is usually much greater. Decisions should be individualized with your doctor.Can diet alone treat CIDP?
No. A healthy, anti-inflammatory diet supports general health and may help symptoms such as fatigue and weight gain, but it cannot replace immune therapies like IVIG, steroids or efgartigimod. Food and supplements should be seen as helpful partners, not substitutes.Are “immune boosters” safe if I have CIDP?
Many over-the-counter “immune boosters” are poorly studied and could interfere with prescription immune-suppressing medicines. Because CIDP is an autoimmune disease, boosting immunity in the wrong way could even be harmful. Always discuss any such products with your neurologist or pharmacist before using them.Will I always feel tired?
Fatigue is common in CIDP, but it can improve with good disease control, physiotherapy, sleep hygiene, treatment of pain and mood problems, and careful pacing of activities. It may not disappear completely, but it often becomes much more manageable.Can children or teenagers get CIDP?
Yes, CIDP can occur in younger people, though it is less common. Diagnosis and treatment are similar but adjusted for age and growth. Paediatric neurologists and rehabilitation teams play a key role, and school support is often needed.Where can I find reliable information and support?
Reliable sources include major neurology centres, national neuromuscular foundations, and peer-reviewed medical reviews about CIDP. Neurologists and specialist nurses can guide you to patient booklets and trusted websites. Joining support groups can also help you learn from others living with CIDP in everyday life.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 24, 2026.
