Which patients are most likely to benefit from immunotherapy in Guillain-Barre syndrome (GBS)?

Updated: May 04, 2018
  • Author: Michael T Andary, MD, MS; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Immunomodulatory therapy, such as plasmapheresis or the administration of intravenous immunoglobulins (IVIGs), is frequently used in patients with Guillain-Barré syndrome (GBS). [140] The efficacy of plasmapheresis and IVIGs appears to be about equal in shortening the average duration of disease. [115, 116, 117, 118, 141] Combined treatment has not been shown to produce a further, statistically significant reduction in disability.

A study by Lin et al indicated that the pretreatment severity score has the strongest association with therapeutic outcome in patients with GBS who undergo double-filtration plasmapheresis, with a higher score being linked to a poorer outcome. The study involved 60 GBS patients who underwent first-line therapy with the procedure. [142]

The decision to use immunomodulatory therapy is based on the disease's severity and rate of progression, as well as on the length of time between the condition's first symptom and its presentation. Risks, such as thrombotic events associated with IVIG, should be taken into consideration. [143, 144] Patients with severe, rapidly progressive disease are most likely to benefit from treatment, with faster functional recovery. [145]


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