Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study. Issue 2 (5th October 2019)

• Record Type: Journal Article
• Authors: Verboon, Christine; van den Berg, Bianca; Cornblath, David R; Venema, Esmee; Gorson, Kenneth C; Lunn, Michael P; Lingsma, Hester; Van den Bergh, Peter; Harbo, Thomas; Bateman, Kathleen; Pereon, Yann; Sindrup, Søren H; Kusunoki, Susumu; Miller, James; Islam, Zhahirul; Hartung, Hans-Peter; Chavada, Govindsinh; Jacobs, Bart C; Hughes, Richard A C; van Doorn, Pieter A
• Other Names: author non-byline.; Ajroud-Driss S author non-byline.; Antonini G author non-byline.; Attarian S author non-byline.; Barroso F A author non-byline.; Benedetti L author non-byline.; Bertorini T E author non-byline.; Brannagan T H author non-byline.; Briani C author non-byline.; Bhavaraju-Sanka R author non-byline.; Butterworth S author non-byline.; Casasnovas C author non-byline.; Cavaletti G author non-byline.; Chen S author non-byline.; Claeys K G author non-byline.; Cosgrove J S author non-byline.; Davidson A author non-byline.; Dardiotis E author non-byline.; Dornonville de la Cour C author non-byline.; Faber C G author non-byline.; Feasby T E author non-byline.; Fujioka T author non-byline.; Galassi G author non-byline.; Gilchrist J M author non-byline.; Goyal N A author non-byline.; Granit V author non-byline.; Gutiérrez-Gutiérrez G author non-byline.; Hadden R D M author non-byline.; Holt J K L author non-byline.; Htut M author non-byline.; Jericó Pascual I author non-byline.; Karafiath S author non-byline.; Katzberg H D author non-byline.; Kiers L author non-byline.; Kieseier B C author non-byline.; Kimpinski K author non-byline.; Kuwabara S author non-byline.; Kwan J Y author non-byline.; Ladha S S author non-byline.; Lawson V author non-byline.; Lehmann H author non-byline.; Manji H author non-byline.; Marfia G A author non-byline.; Márquez Infante C author non-byline.; Mattiazzi M G author non-byline.; McDermott C J author non-byline.; Monges M S author non-byline.; Morís de la Tassa G author non-byline.; Nascimbene C author non-byline.; Nobile Orazio E author non-byline.; Nowak R J author non-byline.; Osei-Bonsu M author non-byline.; Pardo Fernandez J author non-byline.; Querol Gutierrez L author non-byline.; Reisin R author non-byline.; Rinaldi S author non-byline.; Rojas-Marcos I author non-byline.; Rudnicki S A author non-byline.; Schenone A author non-byline.; Sedano Tous M J author non-byline.; Shahrizaila N author non-byline.; Sheikh K author non-byline.; Silvestri N J author non-byline.; Sommer C L author non-byline.; Varrato J D author non-byline.; Verschuuren J author non-byline.; Vytopil M V author non-byline.; Zhou L author non-byline.; Bella I R author non-byline.; Bunschoten C author non-byline.; Bürmann J author non-byline.; Busby M author non-byline.; Chao C C author non-byline.; Conti M E author non-byline.; Dalakas M C author non-byline.; Van Damme P author non-byline.; Doets A author non-byline.; van Dijk G W author non-byline.; Dimachkie M M author non-byline.; Doppler K author non-byline.; Echaniz-Laguna A author non-byline.; Eftimov F author non-byline.; Fazio R author non-byline.; Fokke C author non-byline.; Fulgenzi E A author non-byline.; Garssen M P J author non-byline.; Gijsbers C J author non-byline.; Gilhuis J author non-byline.; Grapperon A author non-byline.; Hsieh S T author non-byline.; Illa I author non-byline.; Islam B author non-byline.; Jellema K author non-byline.; Kaida K author non-byline.; Kokubun N author non-byline.; Kolb N author non-byline.; van Koningsveld R author non-byline.; van der Kooi A J author non-byline.; Kuitwaard K author non-byline.; Landschoff Lassen L author non-byline.; Leonhard S E author non-byline.; Mandarakas M author non-byline.; Martinez Hernandez E author non-byline.; Mohammad Q D author non-byline.; Pulley M author non-byline.; Rajabally Y A author non-byline.; Reddel S W author non-byline.; van der Ree T author non-byline.; Roodbol J author non-byline.; Sachs G M author non-byline.; Samijn J P A author non-byline.; Santoro L author non-byline.; Stein B author non-byline.; Vermeij F H author non-byline.; Visser L H author non-byline.; Willison H J author non-byline.; Wirtz P author non-byline.; Zivkovich S A author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 91:Issue 2(2020)
• Page Start: 113
• Page End: 121
• Publication Date: 2019-10-05
• Subjects: Guillain-Barré syndrome -- poor prognosis -- treatment -- second IVIg course; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2019-321496
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. Methods: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. Results: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1–2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2–4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. Conclusions: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.