Objectivity, practicality, and significance of practice guidelines for the practicing neurologists: What we learnt from consensus criteria in CIDP, Myasthenia Gravis and Inflammatory Myopathies.

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Clinical Guidelines
Authored By
Dalakas MC
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Neurology
Internal/Family Medicine
Speciality
Neurology
Internal/Family Medicine
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volume
16
ISSN
1756-2856
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1756-2856
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true
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["Dalakas MC","Publisher: SAGE Country of Publication: England NLM ID: 101480242 Publication Model: eCollection Cited Medium: Print ISSN: 1756-2856 (Print) Linking ISSN: 17562856 NLM ISO Abbreviation: Ther Adv Neurol Disord Subsets: PubMed not MEDLINE","Journal Article; Review","2023-09-04","Therapeutic advances in neurological disorders [Ther Adv Neurol Disord] 2023 Sep 04; Vol. 16, pp. 17562864231194821. Date of Electronic Publication: 2023 Sep 04 (Print Publication: 2023).","English","Therapeutic advances in neurological disorders","16"]
Description
The value of practice guidelines in the three most common autoimmune neuromuscular disorders, namely Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Myasthenia Gravis (MG) and Autoimmune Inflammatory Myopathies (AIM), has been extensively debated regarding their usefulness in clinical practice, objectivity and universal value considering that guidelines are also established regionally in certain countries. This commentary highlights common concerns on how guidelines are presently generated, pointing out: (a) non-sufficient diversity among Task-Force members to identify and address not only routine clinical and electrophysiology issues but also immunology, imaging, pathology, biomarkers, epidemiology or treatment economics; (b) Task-Force being often comprised by the same or seemingly like-minded members conveying the erroneous impression that experts with opposing views might have been excluded, even if this is clearly not the case; and (c) relying on web-based registries or retrospective data collections from heterogeneous sources. As a result, the existing practice guidelines in CIDP, MG and AIM remain an unfinished business but an excellent base for further enhancement. Guidelines can be extremely helpful not only for clinical trials but also in clinical practice if viewed as a living document with continuously updated versions by experts even with opposing views with precise information on diagnostics, pathomechanisms, therapeutic schemes, evolving biomarkers and economics of new therapies with validation of the post-guidelines criteria. Geographic diversity should be taken into consideration because the availability of biomarker testing, and therapies differ among countries. Patient preferences need to be also considered in therapeutic guidelines because newly marketed drugs offer more options steadily changing the therapeutic algorithms in autoimmune neuromuscular diseases generating also questions as to whether they also influence decisions on insurance coverage. Collectively, these startup considerations are aimed to make practice guidelines more objective, widely acceptable worldwide and more practical or easier to follow in clinical practice.<br />Competing Interests: The author declares that there is no conflict of interest.<br /> (© The Author(s), 2023.)
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