Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study

IGOS Consortium, Christine Verboon, Thomas Harbo, David R Cornblath, Richard A C Hughes, Pieter A van Doorn, Michael P Lunn, Kenneth C Gorson, Fabio Barroso, Satoshi Kuwabara, Giuliana Galassi, Helmar C Lehmann, Susumu Kusunoki, Ricardo C Reisin, Davide Binda, Guido Cavaletti, Bart C Jacobs

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Abstract

OBJECTIVE: To compare the disease course in patients with mild Guillain-Barré syndrome (GBS) who were treated with intravenous immunoglobulin (IVIg) or supportive care only.

METHODS: We selected patients from the prospective observational International GBS Outcome Study (IGOS) who were able to walk independently at study entry (mild GBS), treated with one IVIg course or supportive care. The primary endpoint was the GBS disability score four weeks after study entry, assessed by multivariable ordinal regression analysis.

RESULTS: Of 188 eligible patients, 148 (79%) were treated with IVIg and 40 (21%) with supportive care. The IVIg group was more disabled at baseline. IVIg treatment was not associated with lower GBS disability scores at 4 weeks (adjusted OR (aOR) 1.62, 95% CI 0.63 to 4.13). Nearly all secondary endpoints showed no benefit from IVIg, although the time to regain full muscle strength was shorter (28 vs 56 days, p=0.03) and reported pain at 26 weeks was lower (n=26/121, 22% vs n=12/30, 40%, p=0.04) in the IVIg treated patients. In the subanalysis with persistent mild GBS in the first 2 weeks, the aOR for a lower GBS disability score at 4 weeks was 2.32 (95% CI 0.76 to 7.13). At 1 year, 40% of all patients had residual symptoms.

CONCLUSION: In patients with mild GBS, one course of IVIg did not improve the overall disease course. The certainty of this conclusion is limited by confounding factors, selection bias and wide confidence limits. Residual symptoms were often present after one year, indicating the need for better treatments in mild GBS.

Original languageEnglish
Pages (from-to)1080-1088
Number of pages9
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume92
Issue number10
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
This study is mainly funded by the Interlaken Leadership Awards 2014
from CSL Behring (ILA-2014, https://www.interlakenleadershipawards.com/pastrecipients.aspx). Other sponsors of IGOS are the GBS-CIDP Foundation International,
grifols, GAIN Charity, Erasmus University Medical Centre, Glasgow University, CSL
Behring and Annexon.

Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.

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