Treatment of Guillain-Barré syndrome with corticosteroids: lack of benefit?

Abstract

Guillain-Barré syndrome is an acute inflammatory neuropathy thought to be due to an autoimmune disease that ought to respond to corticosteroid treatment. The puzzle is that it does not. In this issue of The Lancet, Rinske van Koningsveld and colleagues describe a high-quality trial in which 233 patients were randomised to receive intravenous methylprednisolone 500 mg daily for 5 days or placebo, in addition to standard treatment with intravenous immunoglobulin. For the primary outcome measure, after 4 weeks, slightly more patients on the corticosteroid (68%) had improved one grade or more on a simple seven-point disability scale 1 Hughes RAC Newsom-Davis JM Perkin GD Pierce JM Controlled trial of prednisolone in acute polyneuropathy. Lancet. 1978; 2: 750-753 Summary PubMed Scopus (801) Google Scholar than patients on placebo (56%). This difference did not reach the significance level of p<0·03 required by the statistical design. After further analysis allowing for selected expected prognostic baseline variables, including age and disease severity, this result just reached statistical significance. However, the effect size was small and none of the secondary outcome measures were significantly different. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome: randomised trialWe noted no significant difference between treatment with methylprednisolone and IVIg and IVIg alone. Because of the relevance of prognostic factors and the limited side-effects of methylprednisolone, the potential importance of combination treatment with the drug and IVIg, however, warrants further investigation. Full-Text PDF Department of ErrorHughes RAC. Treatment of Guillain-Barré syndrome with corticosteroids: lack of benefit? Lancet 2004; 363: 181—In this Commentary (Jan 17), the last sentence of paragraph two should have read: “Meta-analysis of the two intravenous methylprednisolone trials alone shows 0·17 (−0·06 to 0·39) more improvement in the corticosteroid than the placebo-treated patients, which is still not significant.” Full-Text PDF