Cochrane Summaries

Trusted evidence. Informed decisions. Better health.
Language:
English

Intravenous immunoglobulin for Guillain-Barré syndrome Updated

Hughes RAC, Swan AV, van Doorn PA
Published Online: 
19 September 2014

Review question

Intravenous immunoglobulin (IVIg) is a treatment in which antibodies from donated blood are injected into a person's vein. We wanted to find out whether IVIg can speed up recovery from Guillain-Barré syndrome (GBS).

Background

GBS is an uncommon disease of the nerves outside the brain and spinal cord. It causes weakness, numbness and breathing difficulty. Another Cochrane review has shown that plasma exchange (PE) works better than supportive care alone in GBS. In PE, the liquid part of a person’s blood (plasma) is replaced with a plasma substitute to remove antibodies.

Study characteristics

We included trials of IVIg compared to no treatment, dummy treatment, PE, immunoabsorption (in which specific antibodies are removed from blood) or other immune treatments. We also considered trials of IVIg added to another treatment. We found 12 trials. Some of these compared more than two treatments.

- Seven trials compared IVIg with PE (in 623 participants with severe GBS).

- One compared PE alone to PE followed by IVIg (in 249 participants).

- Three compared IVIg with supportive care (in a total of 75 children).

- One compared a two-day to a five-day IVIg treatment plan (in 51 children).

- One compared IVIg with immunoabsorption (in 48 participants).

- One compared IVIg plus immunoabsorption with immunoabsorption (in 34 participants).

For this review, we chose change in a disability scale after four weeks’ treatment as the main measure of the effect of IVIg.

Key results and quality of the evidence

Five of the trials comparing IVIg and PE measured change in disability. IVIg and PE produced a similar amount of improvement in disability in the 536 trial participants. This evidence was of moderate quality. Harmful effects were no more frequent with PE or IVIg, but people were more likely to finish a course of IVIg.

In one trial involving 249 participants who received PE or PE followed by IVIg, there was slightly more improvement from PE and IVIg together. The effect was probably not large enough to be noticeable but the results do not rule out the possibility. This evidence was of moderate quality.

Three studies in children suggested that IVIg speeds up recovery compared with supportive care. Only one used the disability scale. They provided low quality evidence.

Small trials in children showed more improvement in disability with high-dose than low-dose IVIg but the size of the trials does not permit a firm conclusion. The effect on disability appeared similar with a standard dose over two days rather than five days.

Giving IVIg after immunoabsorption provided no extra benefit over immunoabsorption alone. No conclusions can be drawn from the trial comparing IVIg with immunoabsorption.

The risk of bias in the included studies was variable.

More research is needed to find the best dose of IVIg in adults and children, and one trial of giving a second dose to people who otherwise would be expected to do badly is in progress.

The evidence is current to December 2013.

This record should be cited as: 
Hughes RAC, Swan AV, van Doorn PA. Intravenous immunoglobulin for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD002063. DOI: 10.1002/14651858.CD002063.pub6
Assessed as up to date: 
2 December 2013