IVIG as Effective as Plasma Exchange in Treating Guillain Barré Syndrome

In a meta-analysis of seven Cochrane trials to determine the efficacy of intravenous immunoglobulin (IVIG) for treating Guillain Barré syndrome, IVIG was as effective as plasma exchange (PE) in reducing disability scores, with no significant difference in adverse events.

The randomized and quasi-randomized trials with a variable risk of bias compared IVIG with PE in 623 severely affected participants. In five trials with 536 participants for whom the outcome was available, the mean difference (MD) of change in a seven-grade disability scale after four weeks was not significantly different between the two treatments: MD of 0.02 of a grade more improvement in the IVIG than the PE group (95% confidence interval (CI) 0.25 to -0.20). There also were no statistically significant differences in the other measures considered. Three studies including a total of 75 children suggested that IVIG significantly hastens recovery compared with supportive care. In one trial involving 249 participants comparing PE followed by IVIG with PE alone, the mean grade improvement was 0.2 (95% CI -0.14 to 0.54) more in the combined treatment group than in the PE alone group. Another trial with 37 participants comparing immunoabsorption followed by IVIG with immunoabsorption alone did not reveal significant extra benefit from the combined treatment.

Adverse events were not significantly more frequent with either treatment, but IVIG is significantly much more likely to be completed than PE. Small trials in children showed a trend toward more improvement with high-dose compared with low-dose IVIG, and no significant difference when the standard dose was given over two days rather than five days.