Outcomes in Guillain-Barré Syndrome following a second therapeutic cycle – A single-centre retrospective observational study

Abstract

IntroductionThe treatment of Guillain-Barré Syndrome (GBS) with intravenous immunoglobulin (IVIg) or plasma exchange (PE) reduces time to clinical recovery. Although sometimes used in clinical practice, the benefit of a second treatment cycle is of unproven benefit. AimsOur aim was to compare GBS prognosis in patients treated with one or two cycles of IVIg or PE. MethodsWe selected patients with electrophysiological studies compatible with acute inflammatory demyelinating polyneuropathy or acute motor-sensory axonal neuropathy, from January 2018 to December 2020 in our hospital. Our primary outcome was any improvement in the Guillain-Barré Syndrome Disability Score (GBS-DS) at a mean of twelve weeks. We compared patients treated with one or two treatment cycles with a binary regression. ResultsWe included twenty-six patients, 65.4% with the classical presentation and 30.8% were treated with two cycles. Patients treated with two cycles presented a higher basal GBS-DS (median 4; IQR 1–5) compared with the group of patients treated with one cycle (median 3; IQR 1–5), p = 0.01. The remaining basal characteristics were similar between groups. The two-cycle treatment regimen did not associate with an improvement in GBS-DS (OR 0.28, 95% CI 0.03–2.35, p = 0.24). Likewise there was no benefit in the need for intensive care unit (OR 2.0, 95% CI 0.37–10.92, p = 0.42) or mechanical invasive ventilation (OR 10.2, 95% CI 0.86–120.96, p = 0.66). DiscussionOur analysis reinforces the recent literature data regarding the absence of benefit of two treatment cycles in patients with GBS.