AI Article Synopsis
- The study aimed to evaluate the effectiveness of one versus two courses of intravenous immunoglobulin (IVIg) treatment in Guillain-Barré syndrome (GBS) patients with poor prognosis.
- Researchers analyzed data from the International GBS Outcome Study, focusing on patients with a modified Erasmus GBS Outcome Score indicating poor prognosis, and found no significant improvement in disability scores after a second IVIg course.
- The findings suggest that a second IVIg treatment didn't lead to better outcomes, highlighting the need for a controlled trial to further investigate its potential benefits in GBS treatment.
Article 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.
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| http://dx.doi.org/10.1136/jnnp-2019-321496 | DOI Listing |
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