Neuropathies

Second dose of intravenous immunoglobulin for Guillain-Barre syndrome

No benefit from second dose of immunoglobulin treatment for severe Guillain-Barre syndrome.

The preliminary results of the Dutch SIDGBS (second dose of intravenous immunoglobulin for severe Guillain-Barre syndrome) were presented at the Peripheral Nerve Society meeting in Genoa, June 2019.

Previous pharmacokinetic studies had suggested a relationship between prognosis and the rise of IgG after immunoglobulin treatment in Guillain-Barre syndrome. It could be hypothesized that in some patients, a higher dose of immunoglobulin treatment may have a favourable effect on outcome. In practice, many neurologists worldwide have used this approach particularly in severe cases, despite the absence of evidence.

Disappointingly, SIDGBS was a negative trial. However, this result is very important with considerable practical implications on treatment considerations, not only in view of the negative results, but also taking into account the often poorly recognised, potential delirious effects of immunoglobulin therapy, particularly with regards thromboembolic complications. Repeated exposure to immunoglobulins appears now unjustified.

The impact of the findings on general neurological practice are considerable, given the widespread practice of repeated treatment in patients with Guillain-Barre syndrome, despite lack of evidence to justify this.

 

Full results are awaited.

Key points:

  • Although widespread in practice, use of a second dose of immunoglobulins for Guillain-Barre syndrome has so far remained without an evidence base.
  • A second dose of immunoglobulins is not effective in severe Guillain-Barre syndrome
  • Given the thromboembolic complications of immunoglobulin therapy, active avoidance of repeat immunoglobulin treatment appears justified.

 

References:

 

Pharmacokinetics of intravenous immunoglobulin and outcome in Guillain-Barré syndrome.
Kuitwaard K, de Gelder J, Tio-Gillen AP, Hop WC, van Gelder T, van Toorenenbergen AW, van Doorn PA, Jacobs BC.
Ann Neurol. 2009 Nov;66(5):597-603. doi: 10.1002/ana.21737. PMID:19938102
SIDGBS Trial report, PNS Meeting, Genoa, June 2019.