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Verboon C, Harbo T, Cornblath DR, et al. Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study. J Neurol Neurosurg Psychiatry. 2021;92(10):1080-1088doi: 10.1136/jnnp-2020-325815.
Verboon, C., Harbo, T., Cornblath, D. R., Hughes, R. A. C., van Doorn, P. A., Lunn, M. P., Gorson, K. C., Barroso, F., Kuwabara, S., Galassi, G., Lehmann, H. C., Kusunoki, S., Reisin, R. C., Binda, D., Cavaletti, G., Jacobs, B. C. (2021). Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study. Journal of neurology, neurosurgery, and psychiatry, 92(10), 1080-1088. https://doi.org/10.1136/jnnp-2020-325815
Verboon, Christine, et al. "Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study." Journal of neurology, neurosurgery, and psychiatry vol. 92,10 (2021): 1080-1088. doi: https://doi.org/10.1136/jnnp-2020-325815
Verboon C, Harbo T, Cornblath DR, Hughes RAC, van Doorn PA, Lunn MP, Gorson KC, Barroso F, Kuwabara S, Galassi G, Lehmann HC, Kusunoki S, Reisin RC, Binda D, Cavaletti G, Jacobs BC. Intravenous immunoglobulin treatment for mild Guillain-Barré syndrome: an international observational study. J Neurol Neurosurg Psychiatry. 2021 Oct;92(10):1080-1088. doi: 10.1136/jnnp-2020-325815. Epub 2021 Jun 08. PMID: 34103340; PMCID: PMC8458059.
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J Neurol Neurosurg Psychiatry. 2021 Oct;92(10):1080-1088. doi: 10.1136/jnnp-2020-325815. Epub 2021 Jun 08.

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

Journal of neurology, neurosurgery, and psychiatry

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,

Affiliations

  1. Department of Neurology, Erasmus MC, Rotterdam, The Netherlands.
  2. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
  3. Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
  4. Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK.
  5. Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts, USA.
  6. Department of Neurology, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Buenos Aires, Argentina.
  7. Department of Neurology, Chiba University, Chiba, Japan.
  8. Department of Neurology, University Hospital of Modena, Modena, Italy.
  9. Department of Neurology, University Hospital of Cologne, Cologne, Germany.
  10. Department of Neurology, Kindai University, Osaka, Japan.
  11. Department of Neurology, Hospital Britanico, Buenos Aires, Argentina.
  12. Department of Neurology, University Milano-Bicocca, Monza, Italy.
  13. Department of Neurology, Erasmus MC, Rotterdam, The Netherlands [email protected].
  14. Department of Immunology, Erasmus MC, Rotterdam, The Netherlands.

PMID: 34103340 PMCID: PMC8458059 DOI: 10.1136/jnnp-2020-325815

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.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Conflict of interest statement

Competing interests: DRC is a consultant to Amgen, Annexon Biosciences, argenx SE, Biotest Pharmaceuticals, Boehringer Ingelheim, Cigna Health Management, CSL Behring, Grifols S.A., Neuropore, New Ent

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