What is the treatment for Guillain-Barré Syndrome (GBS)?

From the Guidelines

Intravenous immunoglobulin (IVIG) at 0.4 g/kg daily for 5 consecutive days is the recommended treatment for Guillain-Barré syndrome (GBS) due to its ease of administration, wide availability, and reduced frequency of adverse effects compared to plasma exchange. The treatment of GBS focuses on immunotherapy and supportive care, with IVIG and plasma exchange being the two main immunotherapy options 1. These treatments are most effective when started within the first two weeks of symptom onset. Supportive care is crucial and includes:

• Respiratory monitoring with frequent vital capacity measurements, as 25-30% of patients may require mechanical ventilation
• Deep vein thrombosis prophylaxis
• Pain management with gabapentin (300-1200 mg three times daily) or carbamazepine (200-400 mg twice daily)
• Physical therapy should be initiated early
• Autonomic dysfunction may require treatment for blood pressure fluctuations, cardiac arrhythmias, or urinary retention

The choice between IVIG and plasma exchange depends on various factors, including availability, cost, and patient-specific considerations 1. However, IVIG is generally considered the first choice of treatment due to its ease of administration and reduced frequency of adverse effects. Plasma exchange, on the other hand, is less costly than IVIG and could be a preferred treatment option in low-income and middle-income countries (LMIC) where resources are limited 1. Nevertheless, the efficacy of these therapies might differ in LMIC, where different subtypes of GBS are prevalent, and patients usually present to hospital in the later stages of disease 1.

In resource-limited settings, small-volume plasma exchange (SVPE) is a novel, relatively low-cost technique for selective removal of plasma and has been shown to be a safe and feasible treatment for GBS 1. However, large-scale studies are required to establish its efficacy before it can be implemented in routine clinical practice. Complement inhibitors, such as eculizumab, are a new focus in the treatment of GBS in high-income countries (HIC) and are currently being studied 1.

From the Research

Treatment Options for Guillain-Barré Syndrome

• Intravenous immunoglobulin (IVIg) is a beneficial treatment for Guillain-Barré syndrome (GBS), as shown in a study published in 2014 2.
• Plasma exchange (PE) is also an effective treatment for GBS, and has been shown to be superior to supportive treatment alone in several studies, including one published in 2002 3.
• A study published in 1998 found that IVIg therapy is equally effective as PE for the treatment of GBS, and offers some advantages over PE, including being better tolerated and easier to administer 4.
• The combination of IVIg and PE has been studied, and a review published in 2014 found that adding IVIg to PE did not confer significant extra benefit, although the evidence was not conclusive 2.
• A retrospective chart review published in 2010 found that IVIg followed by PE was not more effective than IVIg alone, and was associated with increased cost and duration of hospitalization 5.
• A study published in 2021 found that IVIg treatment did not improve the overall disease course in patients with mild GBS, although it may have some benefits, such as shorter time to regain full muscle strength and lower reported pain at 26 weeks 6.

Comparison of Treatment Outcomes

• A review published in 2014 found that IVIg and PE had similar outcomes in terms of disability grade at four weeks, although IVIg was more likely to be completed than PE 2.
• A study published in 2002 found that PE was beneficial in patients with mild, moderate, and severe GBS, and that the benefit was greater when started within seven days of disease onset 3.
• A study published in 2021 found that IVIg treatment did not improve the overall disease course in patients with mild GBS, and that residual symptoms were often present after one year 6.

Adverse Events and Safety

• A review published in 2014 found that adverse events were not significantly more frequent with IVIg or PE, although IVIg was more likely to be completed than PE 2.
• A study published in 2002 found that PE was associated with fewer infectious events and cardiac arrhythmias than supportive treatment alone 3.
• A study published in 2021 found that IVIg treatment was well-tolerated, although the certainty of this conclusion was limited by confounding factors and selection bias 6.