From the Guidelines
Intravenous immunoglobulin (IVIG) is the recommended first-line treatment for Guillain-Barré syndrome (GBS) due to its ability to rapidly neutralize autoantibodies and modulate the immune response, leading to faster recovery times and reduced disease severity, as supported by the most recent and highest quality study 1.
Benefits and Risks of IVIG
The primary benefits of IVIG include:
- Faster recovery times
- Reduced disease severity
- Shorter hospital stays
- Reduced need for mechanical ventilation
- Improved long-term outcomes compared to supportive care alone However, IVIG also carries risks, including:
- Infusion reactions (headache, fever, chills)
- Thromboembolic events due to increased blood viscosity
- Aseptic meningitis
- Acute kidney injury
- Rarely, anaphylaxis in IgA-deficient patients
Administration and Monitoring
IVIG is typically administered at a dose of 0.4 g/kg/day for 5 consecutive days (total dose 2 g/kg), with treatment ideally started within the first two weeks of symptom onset for maximum effectiveness 1. Patients with pre-existing cardiac or renal disease require careful monitoring during treatment.
Comparison to Plasma Exchange
IVIG has similar efficacy to plasma exchange but is generally considered the treatment of choice due to its ease of administration and wider availability 1. However, plasma exchange may be considered in certain situations, such as in low-income and middle-income countries where IVIG is not affordable 1.
Special Considerations
In resource-limited settings, small volume plasma exchange (SVPE) may be a viable alternative to IVIG, but further studies are needed to establish its efficacy 1. Additionally, complement inhibitors, such as eculizumab, are being studied as potential new treatments for GBS in high-income countries 1.
From the Research
Risks and Benefits of IVIG for Guillain-Barré Syndrome
- The efficacy of Intravenous Immunoglobulin (IVIG) in treating Guillain-Barré Syndrome (GBS) may vary depending on the subtype of the disease 2.
- IVIG is beneficial in acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variants of GBS, but not in the acute motor axonal neuropathy (AMAN) subtype 2.
- Compared to the natural course of the disease, IVIG treatment results in a lesser proportion of patients with poor recovery at 6 months 2.
- IVIG hastens recovery in GBS patients as much as plasma exchange, especially when started within two weeks from onset 3, 4.
- Adverse events are not significantly more frequent with IVIG compared to plasma exchange, but IVIG is more likely to be completed than plasma exchange 3, 4.
- The use of IVIG after plasma exchange does not confer significant extra benefit 3, 4.
- High-dose IVIG may be more effective than low-dose IVIG in children, but more research is needed to determine the optimal dose 3, 4.
- IVIG offers advantages over plasma exchange, including better tolerance and ease of administration 5.
- However, the treatment of GBS patients with IVIG requires qualified neurologic and supportive care due to the possibility of progression 5.
- A clinical prognostic scoring scale, such as the Erasmus GBS Outcome Scale (EGOS), can be used to select GBS patients with a poor prognosis who may benefit from a second IVIG dose 6.