The efficacy and safety of high-dose, intermittent IV methylprednisolone (IVMP) as initial and long-term maintenance therapy for chronic inflammatory demyelinating polyneuropathy (CIDP) were analyzed by a retrospective review of outcome data derived from patients’ medical records between 1992 and 2003 at Washington University School of Medicine, St Louis, MO. Of 57 patients with clinical and electrophysiologic evidence of CIDP, 39 had sufficient data to classify and compare patients in 3 cohorts according to their primary treatment with IVMP, IVIg, or oral immunosuppression with prednisone or cyclosporine. There was no significant difference in mean improvement of quantitative muscle testing (hand dynamometer) at 6 months or at the last clinic visit (average 4.5 years later) among the 3 groups. At the last visit, 81% to 88% improved in all groups. Weight gain and cushingoid features were less frequent in patients treated with IVMP (19%) than in those receiving oral prednisone (58%). 
COMMENT. IVMP is as effective in improving and maintaining strength in patients with CIDP as is IVIg or oral prednisone, and has fewer adverse effects. The authors recommend IVMP as initial and maintenance therapy in CIDP patients with weakness or disability.