Intravenous immunoglobulin for Guillain-Barré syndrome

Guillain-Barré syndrome is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin is beneficial in other autoimmune diseases. We aimed to determine the efficacy of intravenous immunoglobulin for Guillain-Barré syndrome. We updated the searches of the Cochrane Neuromu...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2010-06 (6), p.CD002063-CD002063
Main Authors: Hughes, Richard Ac, Swan, Anthony V, van Doorn, Pieter A
Format: Article
Language:English
Subjects:
Adult
Child
Guillain-Barre Syndrome - therapy
Humans
Immunoglobulins, Intravenous - therapeutic use
Outcome Assessment (Health Care)
Plasma Exchange
Randomized Controlled Trials as Topic
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Summary:Guillain-Barré syndrome is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin is beneficial in other autoimmune diseases. We aimed to determine the efficacy of intravenous immunoglobulin for Guillain-Barré syndrome. We updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register, MEDLINE and EMBASE in June 2009 using the terms 'Guillain-Barré syndrome' and 'acute polyradiculoneuritis' combined with 'intravenous immunoglobulin'. We included randomised and quasi-randomised trials. Two authors independently selected papers, extracted data and assessed quality. Another Cochrane systematic review has shown that plasma exchange significantly hastens recovery. In this review, five trials compared intravenous immunoglobulin with plasma exchange in 536 severely affected, mostly adult participants. The mean difference of change in a seven-grade disability scale after four weeks was not significantly different between the two treatments: 0.02 (95% CI 0.25 to -0.20) of a grade more improvement in the intravenous immunoglobulin than the plasma exchange group. There were also no statistically significant differences in the other measures considered. Three studies including a total of 75 children suggested that intravenous immunoglobulin significantly hastens recovery compared with supportive care.In one trial involving 249 participants comparing plasma exchange followed by intravenous immunoglobulin with plasma exchange alone, the mean grade improvement was 0.2 (95% CI -0.14 to 0.54) more in the combined treatment group than in the plasma exchange alone group, not significantly different but not excluding the possibility of significant extra benefit. Another trial with 37 participants comparing immunoabsorption followed by intravenous immunoglobulin with immunoabsorption alone did not reveal significant extra benefit from the combined treatment.Small trials in children showed a trend towards more improvement with high-dose compared with low-dose intravenous immunoglobulin and no significant difference when the standard dose was given over two days rather than five days. A previous Cochrane review has shown that plasma exchange hastens recovery compared with supportive treatment alone. There are no adequate comparisons of intravenous immunoglobulin with placebo in adults but this review provides moderate quality evidence that, in severe disease, intravenous immunoglobulin started within two weeks from o
ISSN:1469-493X
DOI:10.1002/14651858.CD002063.pub4