From the Guidelines
The recommended dose of intravenous immunoglobulin (IVIG) for Guillain-Barré syndrome (GBS) is 0.4 g/kg body weight daily for 5 days. This dose is based on the most recent and highest quality study available, which suggests that IVIG and plasma exchange are equally effective treatments for GBS, with IVIG being easier to administer and more widely available 1. The treatment should be initiated as soon as possible after diagnosis, ideally within the first two weeks of symptom onset, to maximize effectiveness. Some key points to consider when administering IVIG for GBS include:
- Monitoring patients for potential adverse reactions, such as headache, fever, and chills
- Premedicating with acetaminophen and diphenhydramine to reduce infusion-related reactions
- Understanding that IVIG works by neutralizing circulating autoantibodies and interrupting the autoimmune process targeting peripheral nerves in GBS
- Recognizing that IVIG is often preferred over plasma exchange due to its convenience and favorable safety profile, as supported by studies such as 1 and 1. However, the most recent and highest quality study 1 takes precedence in guiding the recommended dose and treatment approach.
From the Research
IVIG Dose for Guillain-Barré Syndrome (GBS)
- The standard dose of IVIG for GBS is 0.4 g/kg bodyweight for 5 days 2.
- Some studies suggest that a single standard dose of IVIG may not be sufficient for all GBS patients, and a second dose may be beneficial for patients with a poor prognosis 2, 3.
- The pharmacokinetics of IVIG can vary between individuals, and patients with a low increase in serum IgG level after standard IVIG treatment may recover more slowly 3.
- High-dose IVIG (400 mg/kg per day for 5 days) has been used to treat GBS in Japanese children, with significant improvement in motor function observed in most patients 4.
- The optimal dose and duration of IVIG treatment for GBS may depend on various factors, including disease severity, patient age, and clinical prognosis 2, 5, 3.
Clinical Factors Associated with IVIG Treatment
- Age, presence of preceding diarrhea, and severity of disability in the early course of disease are important clinical factors associated with poor outcome in GBS patients treated with IVIG 2.
- 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 2.
- IVIG therapy may be more effective in certain subtypes of GBS, such as acute inflammatory demyelinating polyradiculoneuropathy (AIDP), but not in others, such as acute motor axonal neuropathy (AMAN) 5.