Current treatment practice of Guillain-Barré syndrome

Verboon, C. et al. (2019) Current treatment practice of Guillain-Barré syndrome. Neurology, 93(1), e59-e76. (doi: 10.1212/WNL.0000000000007719) (PMID:31175208)

Abstract

Objective: To define the current treatment practice of Guillain-Barré syndrome (GBS). Methods: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. Results: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. Conclusions: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

• Item Type: Articles
• Additional Information: This study is funded by the GBS-CIDP Foundation International, Gain, Erasmus MC University Medical Centre Rotterdam, Glasgow University, CSL Behring, Grifols, and Annexon.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Davidson, Dr Amy and Willison, Professor Hugh
• Authors: Verboon, C., Doets, A. Y., Galassi, G., Davidson, A., Waheed, W., Péréon, Y., Shahrizaila, N., Kusunoki, S., Lehmann, H. C., Harbo, T., Monges, S., Van den Bergh, P., Willison, H. J., Cornblath, D. R., and Jacobs, B. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Neurology
• Publisher: American Academy of Neurology
• ISSN: 0028-3878
• ISSN (Online): 1526-632X
• Published Online: 07 June 2019
• Copyright Holders: Copyright © 2019 American Academy of Neurology
• First Published: First published in Neurology 93(1):e59-e76
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher