What is the recommended dose of Intravenous Immunoglobulin (IVIG) for Guillain-Barré Syndrome (GBS)?

From the Guidelines

The recommended dose of intravenous immunoglobulin (IVIG) for Guillain-Barré syndrome (GBS) is 0.4 g/kg/day for 5 consecutive days, for a total dose of 2 g/kg. This dose is supported by the most recent and highest quality study, which suggests that IVIG and plasma exchange are equally effective treatments for GBS, with IVIG being the preferred treatment due to its ease of administration and wider availability 1. The treatment should be initiated as soon as possible after diagnosis, ideally within the first two weeks of symptom onset for maximum efficacy.

Key Considerations

• IVIG should be administered through a dedicated IV line with an initial infusion rate of 0.5 mL/kg/hour for the first 30 minutes, which can be gradually increased to 4-8 mL/kg/hour if well tolerated.
• Patients should be monitored for potential adverse reactions including headache, fever, chills, myalgia, and rarely, anaphylaxis or thrombotic events.
• Renal function should be assessed before treatment as IVIG can cause acute kidney injury, particularly in patients with pre-existing renal disease or those who are dehydrated.
• IVIG works by neutralizing pathogenic antibodies, blocking Fc receptors, and modulating complement activation, thereby interrupting the autoimmune attack on peripheral nerves in GBS.

Additional Guidance

• If a patient shows initial improvement followed by deterioration (treatment-related fluctuation), a second course of IVIG may be considered, though evidence for this approach is limited 1.
• The use of corticosteroids in GBS is generally not recommended, except in cases where GBS is related to immune checkpoint inhibitor therapy, where a trial of corticosteroids may be reasonable 1.

From the Research

IVIG Dose for GBS

• The standard IVIG dose for Guillain-Barré syndrome (GBS) is 0.4 g/kg/day for 5 consecutive days 2.
• This dose has been shown to be effective in hastening recovery and reducing long-term morbidity from GBS 3.
• Some studies suggest that a higher dose of IVIG may be more effective in severe cases of GBS, but more research is needed to confirm this 3.
• The optimal dose and duration of IVIG treatment for GBS are still being studied, and more research is needed to determine the most effective treatment regimen 3.

Comparison with Other Treatments

• IVIG has been shown to be as effective as plasma exchange (PE) in treating GBS, and may be safer and more convenient 4, 3.
• Some studies suggest that combining IVIG with PE may not provide significant extra benefit, but more research is needed to confirm this 3, 5.
• The choice of treatment for GBS should be individualized based on the patient's specific needs and circumstances 6.

Special Considerations

• Patients with severe GBS may require intensive care and mechanical ventilation, and IVIG treatment should be started as soon as possible after diagnosis 6.
• Patients who do not respond to initial IVIG treatment may benefit from a second course of treatment or alternative therapies such as PE 2, 5.
• More research is needed to determine the optimal treatment approach for patients with mild GBS or those who are treated more than two weeks after onset 3.