Plasma Exchange versus Intravenous Immunoglobulin for the Treatment of Guillain Barre Syndrome.
Shreya Narayan1, Vinay Chandramouli Bellur2, Ananya Prasad2, Advaith Rao2, disha prashanth2, Deepika Reddy Aluru1, Shruthi Raghunandan3, Kushal Prasad1, Era Gupta1
1Bangalore Medical College and Research Institute, 2Ramaiah Medical College, 3Vydehi Institute of Medical Sciences & Research Centre
Objective:

The meta-analysis aims to determine the effectiveness of IV Immunoglobulin(IVIG) therapy in comparison to conventional plasma exchange therapy by assessing the change in disability scores between the 2 groups.


Background:

Guillain-Barré syndrome is an acute inflammatory condition with features of peripheral demyelinating neuropathy that results in severe motor weakness and or paralysis. There is usually a need to advance the treatment process to facilitate better results. Two common therapies are plasma exchange and intravenous immunoglobulin therapy (IVIG) which act by minimizing immune-mediated myelin sheath lysis. IVIG is known to effectively reduce the rate of progress of GBS by multiple mechanisms which include blockade of  Fc receptors on macrophages preventing antibody‐targeted attack on the Schwann cell membrane and myelin and regulation of autoantibodies or cytokines.


Design/Methods:

The review conducted follows the PRISMA guidelines. Major medical databases were searched using an extensive search term. The outcome assessed was the difference in mean disability score between the 2 groups, that is, patients who underwent IVIG therapy and those who underwent plasma exchange/plasmapheresis (control) for Guillain-Barré syndrome.


Results:

The results from our meta-analysis include 150 patients who underwent IV IG therapy and 194 controls (plasma exchange/plasmapheresis) from 6 studies. The outcome measured in our study was the mean disability score between the 2 groups. Compared to the control group (plasma exchange/plasmapheresis), patients on IVIg therapy had a lower disability score. According to the random effects model, the mean difference between the groups was -0.31[-0.60;-0.01, 95%CI, p > 0.01, I^2 = 99%).



Conclusions:
The meta-analysis shows that IVIG therapy is more effective than Plasma exchange in reducing disability scores for Guillain-Barré syndrome. This provides evidence indicating the need for standardized guidelines and further clinical trials of IVIG therapy in GBS as IVIG therapy is effective in reducing the disability associated with GBS.
10.1212/WNL.0000000000211862
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.