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Efficacy and safety of intravenous immunoglobulin retreatment amongst Guillain–Barré syndrome patients who poorly responded to initial IVIG cycle: a systematic review

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Abstract

Introduction

Small cross-sectional studies and case reports observed improvement after administration of second IVIG dose (SID) amongst Guillain–Barré Syndrome (GBS) patients not responsive to initial IVIG cycle. Nevertheless, recent clinical trial and larger observational studies did not find any positive effects of SID. Instead, an increased risk of thromboembolism and mortality was noted. The conclusions of these studies however were not robust as confounding and selection bias were present.

Methodology

Two neurologists conducted the search process (KBA and MBP) using the following terms in Medline: [(“ Guillain-Barré Syndrome”[MeSH Terms] or GBS or Acute Motor Axonal Neuropathy or Acute Motor Axonal Neuropathy or Acute Inflammatory Demyelinating Polyneuropathy) AND (Poorly Responsive or Poor Prognosis or Progressive)] AND [(“Intravenous Immunoglobulin”[MeSH Terms] or IVIG or IGIV) AND (second dose or retreatment or SID)].

Results

Only 7 articles were included in this review. In terms of primary outcomes, although the cross-sectional study found improvement in GBS DS score at 4 weeks (Median GBS DS: 3 vs 5, p = 0.033) and the 2 case series observed improvement after SID, no significant differences between the control and intervention groups were found in the cohort [Early SIV OR: 0.7 (95% CI 0.16–3.04), Late SIV OR: 0.66 (CI: 0.18–2.5)] and clinical trial studies (Adjusted OR: 1.4 (95% CI:0.6–3.3, p = 0.45). Moreover, 4 patients who died in the clinical trial were from the intervention group.

Conclusion

Based on studies with research designs of higher quality, SID is not effective in the management of GBS patients who poorly responded to initial IVIG. Nevertheless, an adequately powered, randomized, double-blinded, placebo-controlled clinical trial, using GBS-DS of 3 and above after first IVIG dose should be done to effectively establish the efficacy and safety of SID as intervention for this cohort of patients.

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Data Availability

Not applicable.

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Acknowledgements

MBP thanks MK statistical services the help in collating the data. Authorship: MBP, KBA, DAD and CRT conceptualised the study. MBP, KBA acquired and analysed the data. MBP drafted the paper. MBP, DAD, CRT and KBA edited and revised the paper.

Funding

The authors did not receive support from any organisation for the submitted work.

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Author notes

  1. Mario B. Prado Jr. and Karen Joy B. Adiao are the Joint Primary Authors.

Authors and Affiliations

  1. Department of Physiology, College of Medicine, University of the Philippines-Manila, Manila, Philippines

    Mario B. Prado Jr., Christian Wilson R. Turalde & Darwin A. Dasig

  2. Department of Internal Medicine, Medical Center Manila, Manila, Philippines

    Karen Joy B. Adiao

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Mario Prado and Karen Joy Adiao. The first draft of the manuscript was written by Mario Prado and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mario B. Prado Jr..

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This is a systematic review. The UPM Research Ethics Committee has confirmed that no ethical approval is required.

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Prado, M.B., Adiao, K.B., Turalde, C.R. et al. Efficacy and safety of intravenous immunoglobulin retreatment amongst Guillain–Barré syndrome patients who poorly responded to initial IVIG cycle: a systematic review. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02518-9

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