Controlled trial of plasma exchange in acute inflammatory polyradiculoneuropathy

Abstract

A randomized controlled trial of exchange versus no exchange was conducted to find out whether plasma exchange would be useful in acute inflammatory polyradiculoneuropathy. It was calculated that 15 patients would be required in each group to demonstrate a worthwhile improvement in functional ability one month after completion of treatment. Treatment comprised five exchanges in 10 days (55 ml plasma/kg body weight/exchange). Both groups received normal supportive care and were followed up periodically for a year. Overall the treated group showed a slight but not significant benefit (p>0.05); at two weeks' follow‐up of patients admitted to the trial within 14 days of onset of neuropathic symptoms, p=0.07. These results do not provide grounds for recommending plasma exchange for the treatment of severe AIP.

Prediction of Early Beneficial Response to Plasma Exchange in Guillain-Barre Syndrome

“…At the institution of PE, the only significant clinical difference between the groups was age (P < .01). The age of the responder group ranged from 14 to 49 years, compared with 15 to 81 years in the nonresponders (Fig 1). The apparent predominance of male nonresponders was not significant (P < .07), nor was preceding illness, initial symptoms, cranial nerve involvement, and cerebrospinal fluid findings.…”

Pharmacoeconomics of therapy for Guillain–Barré syndrome: plasma exchange and intravenous immunoglobulin

“…[15][16][17] Controlled clinical trials have assessed the value of steroids, PE, IVIG and combinations of these treatments. 18,19 The value of PE has been reviewed in six randomized studies. [17][18][19][20] This treatment resulted in significant improvements in time to recover the ability to walk without aid, the percentage of patients requiring artificial ventilation, the duration of ventilation, and severe sequelae at 1 year.…”

“…18,19 The value of PE has been reviewed in six randomized studies. [17][18][19][20] This treatment resulted in significant improvements in time to recover the ability to walk without aid, the percentage of patients requiring artificial ventilation, the duration of ventilation, and severe sequelae at 1 year. In Raphael's review, PE is the only treatment for GBS found to be superior to supportive treatment, 17 and therefore should be the standard against which new treatments such as IVIG are judged.…”

Guillain-Barré syndrome: An update

“…In four trials that included 585 participants, plasmapheresis resulted in significant improvement in clinical features within 4 weeks of randomisation, as indicated by an improvement in disability and increased proportion of patients recovering to full strength within 1 year. [133][134][135][136] In a further five trials with 623 participants, plasmapheresis reduced the percentage of patients requiring ventilation at 4 weeks from 27% to 14%. 7 Plasmapheresis was beneficial within 4 weeks of symptom onset, and the benefit was greatest when the treatment was given early.…”