The purpose of this systematic review was to evaluate recent randomised clinical trials to determine the efficacy and safety of current therapies in the recovery of CIDP. Overall all treatment modalities for CIDP favoured a positive response (OR 2.10, 95% CI 0.96-4.61, p = 0.05) (Figure
1). Two important observations arose from this review; firstly, there is a need to use better objective scales to measure disability and assess long-term outcomes and responses to treatments. Secondly there is a need to be able to identify and omit subjects with stable or inactive disease, as they would be naturally less likely to respond to new or novel treatments. Recent research illustrated that up to 40% of subjects with CIDP were in remission or cured, but included in clinical trials, however CIDP patients can exhibit spontaneously improvement. This may explain why there was a high placebo response rate observed in some clinical trials [
15,
27]. Using a reliable scale such as CIDP Disease Activity Status (CDAS) in patient recruitment for clinical trials would provide more meaningful data with fewer patients. Constructing better powered larger studies would also assist in demonstrating potentially important small differences and in data interpretation. The data from the systematic review identified, that IVIg appeared to provide an effective treatment option for subjects with active CIDP, particularly evident in the studies by Zinman et al. [
22], Latov et al. [
27] and Leger et al. [
24]. Further studies are necessary to investigate plasma factors other than immunoglobulins in IVIg, which may result in an increase in clinical response rates in trials using albumin as placebo. Replacing albumin with isotonic saline would be a better choice for the placebo. As discussed previously, this phenomenon was seen in an IVIg versus placebo trial undertaken by Vermeulen et al. [
25], however the high clinical response rate observed in the control arm may also be due to patients being incorrectly diagnosed or possibly spontaneous recovery from the disorder. Rituximab showed promising results [
31], however larger randomised clinical trials with long-term follow up would be required. Heterogeneity was moderate between the eight randomised controlled studies included (Tau
2 = 0.58, Q = 14.05, I
2 = 50% and p = 0.05) and due to the variability of the disease the binary random effect model was used in this study. This was to be expected as the treatments varied considerably and it was not the purpose of this review to combine studies. The systematic review did not include plasma exchange therapy, however two double crossover trials identified did not fit inclusion criteria and had been previously reported [
35]. The two clinical trials using plasma exchange for the treatment of CIDP demonstrated a significantly better outcome in the treatment groups [
36,
37]. Due to the rarity and numerous variants of CIDP, limited large clinical trials have been undertaken. Clinical trials with similar autoimmune inflammatory diseases such as Guillain–Barré syndrome, multiple sclerosis and Crohn's disease may also provide some guidance in treatment options for those suffering from CIDP. Two compounds, Kv1.3 and KCa3.1 (voltage-gated potassium channel and calcium activated potassium channel inhibitors respectively) have shown promising results in animal studies for the treatment of autoimmune diseases such as multiple sclerosis, psoriasis and type-one diabetes may also benefit subjects with CIDP [
38,
39]. Currently a clinical trial is underway to observe whether alpha lipoic acid, an antioxidant with anti-inflammatory properties may prove effective to treat CIDP symptoms (ClinicalTrials.gov Identifier: NCT00962429). Hematopoietic stem cell transplantation for treating CIDP is also showing some promise [
40], with a clinical trial actively recruiting participants (ClinicalTrials.gov Identifier: NCT00278629). With the development of antigen arrays, customised DNA vaccines may have potential to cure CIDP and other autoimmune disorders by tolerizing against an aberrant immune response observed in subjects with CIDP.