Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

IGOS Consortium; Christine Verboon; Bianca van den Berg; David R Cornblath; Esmee Venema; Kenneth C Gorson; Michael P Lunn; Hester Lingsma; Peter Van den Bergh; Thomas Harbo; Kathleen Bateman; Yann Pereon; Søren H Sindrup; Susumu Kusunoki; James Miller; Zhahirul Islam; Hans-Peter Hartung; Govindsinh Chavada; Bart C Jacobs; Richard A C Hughes; Pieter A van Doorn; Krista Kuitwaard

doi:10.1136/jnnp-2019-321496

Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

IGOS Consortium
, Christine Verboon
, Bianca van den Berg
, David R Cornblath
, Esmee Venema
, Kenneth C Gorson
, Michael P Lunn
, Hester Lingsma
, Peter Van den Bergh
, Thomas Harbo
, Kathleen Bateman
, Yann Pereon
, Søren H Sindrup
, Susumu Kusunoki
, James Miller
, Zhahirul Islam
, Hans-Peter Hartung
, Govindsinh Chavada
, Bart C Jacobs
, Richard A C Hughes

Pieter A van Doorn^*, Krista Kuitwaard

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

52 Citations (Scopus)

Abstract

OBJECTIVE: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.

METHODS: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.

RESULTS: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.

CONCLUSIONS: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

Original language	English
Pages (from-to)	113-121
Number of pages	9
Journal	Journal of Neurology Neurosurgery and Psychiatry
Volume	91
Issue number	2
DOIs	https://doi.org/10.1136/jnnp-2019-321496
Publication status	Published - Feb 2020

Bibliographical note

Funding:
This study is mainly funded by Grifols. Other sponsors of IGOS are GBSCIDP Foundation International, GAIN Charity, Erasmus University Medical Centre,
Glasgow University, CSL Behring and Annexon.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Research programs

EMC MM-02-72-02
EMC MM-04-44-02
EMC NIHES-02-65-01

Access to Document

10.1136/jnnp-2019-321496

Cite this

IGOS Consortium, Verboon, C., van den Berg, B., Cornblath, D. R., Venema, E., Gorson, K. C., Lunn, M. P., Lingsma, H., Van den Bergh, P., Harbo, T., Bateman, K., Pereon, Y., Sindrup, S. H., Kusunoki, S., Miller, J., Islam, Z., Hartung, H.-P., Chavada, G., Jacobs, B. C., ... Kuitwaard, K. (2020). Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study. Journal of Neurology Neurosurgery and Psychiatry, 91(2), 113-121. https://doi.org/10.1136/jnnp-2019-321496

@article{1a35ded0b1414e03b1d0c460d0edf3b8,

title = "Original research: Second IVIg course in Guillain-Barr{\'e} syndrome with poor prognosis: the non-randomised ISID study",

abstract = "OBJECTIVE: To compare disease course in patients with Guillain-Barr{\'e} syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.METHODS: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.RESULTS: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95\%CI 0.16 to 3.04) for the early group and 0.66 (95\%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.CONCLUSIONS: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.",

author = "\{IGOS Consortium\} and Christine Verboon and \{van den Berg\}, Bianca and Cornblath, \{David R\} and Esmee Venema and Gorson, \{Kenneth C\} and Lunn, \{Michael P\} and Hester Lingsma and \{Van den Bergh\}, Peter and Thomas Harbo and Kathleen Bateman and Yann Pereon and Sindrup, \{S{\o}ren H\} and Susumu Kusunoki and James Miller and Zhahirul Islam and Hans-Peter Hartung and Govindsinh Chavada and Jacobs, \{Bart C\} and Hughes, \{Richard A C\} and \{van Doorn\}, \{Pieter A\} and Krista Kuitwaard",

note = "Funding: This study is mainly funded by Grifols. Other sponsors of IGOS are GBSCIDP Foundation International, GAIN Charity, Erasmus University Medical Centre, Glasgow University, CSL Behring and Annexon. {\textcopyright} Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2020",

month = feb,

doi = "10.1136/jnnp-2019-321496",

language = "English",

volume = "91",

pages = "113--121",

journal = "Journal of Neurology Neurosurgery and Psychiatry",

issn = "0022-3050",

publisher = "BMJ Publishing Group",

number = "2",

}

IGOS Consortium, Verboon, C, van den Berg, B, Cornblath, DR, Venema, E, Gorson, KC, Lunn, MP, Lingsma, H, Van den Bergh, P, Harbo, T, Bateman, K, Pereon, Y, Sindrup, SH, Kusunoki, S, Miller, J, Islam, Z, Hartung, H-P, Chavada, G, Jacobs, BC, Hughes, RAC, van Doorn, PA & Kuitwaard, K 2020, 'Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study', Journal of Neurology Neurosurgery and Psychiatry, vol. 91, no. 2, pp. 113-121. https://doi.org/10.1136/jnnp-2019-321496

TY - JOUR

T1 - Original research

T2 - Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

AU - IGOS Consortium

AU - Verboon, Christine

AU - van den Berg, Bianca

AU - Cornblath, David R

AU - Venema, Esmee

AU - Gorson, Kenneth C

AU - Lunn, Michael P

AU - Lingsma, Hester

AU - Van den Bergh, Peter

AU - Harbo, Thomas

AU - Bateman, Kathleen

AU - Pereon, Yann

AU - Sindrup, Søren H

AU - Kusunoki, Susumu

AU - Miller, James

AU - Islam, Zhahirul

AU - Hartung, Hans-Peter

AU - Chavada, Govindsinh

AU - Jacobs, Bart C

AU - Hughes, Richard A C

AU - van Doorn, Pieter A

AU - Kuitwaard, Krista

N1 - Funding: This study is mainly funded by Grifols. Other sponsors of IGOS are GBSCIDP Foundation International, GAIN Charity, Erasmus University Medical Centre, Glasgow University, CSL Behring and Annexon. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2020/2

Y1 - 2020/2

N2 - OBJECTIVE: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.METHODS: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.RESULTS: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.CONCLUSIONS: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

AB - OBJECTIVE: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses.METHODS: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression.RESULTS: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course.CONCLUSIONS: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

U2 - 10.1136/jnnp-2019-321496

DO - 10.1136/jnnp-2019-321496

M3 - Article

C2 - 31586949

SN - 0022-3050

VL - 91

SP - 113

EP - 121

JO - Journal of Neurology Neurosurgery and Psychiatry

JF - Journal of Neurology Neurosurgery and Psychiatry

IS - 2

ER -

Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

Abstract

Bibliographical note

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