Second intravenous immunoglobulin dose in patients with Guillain-Barré syndrome with poor prognosis (SID-GBS): a double-blind, randomised, placebo-controlled trial
RCT (n=93) did not provide evidence that patients with Guillain-Barré syndrome with poor prognosis benefit from second intravenous immunoglobulin course and is accompanied by a risk of serious adverse events, therefore the use of a second course of treatment is not recommended.
Source:
The Lancet Neurology
SPS commentary:
In the study, 49 (53%) received second intravenous immunoglobulin dose (SID) and 44 (47%) received placebo. The adjusted common odds ratio for improvement on the Guillain-Barré syndrome disability score at 4 weeks was 1·4 (95% CI 0·6–3·3; p=0·45). Patients given SID had more serious adverse events (35% vs 16% in the first 30 days), including thromboembolic events, than those in the placebo group.
According to a commentary, a new approach should be to find treatments that rapidly neutralise the immediate and ongoing damage happening as the patient presents. It discusses potential new therapies, but in the interim, highlights the need to stop using the precious intravenous immunoglobulin resource as second doses in severe Guillain-Barré syndrome and concentrate on supporting patients through sometimes prolonged recovery without inadvertently causing additional harm.