Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study

Verboon, Christine; Berg, B. van den; Cornblath, David R.; Venema, Esmée; Gorson, Kenneth C.; Lunn, Michael P.; Lingsma, Hester F.; Bergh, Peter Van den; Harbo, Thomas; Bateman, Kathleen; Péreón, Yann; Sindrup, Søren Hein; Kusunoki, Susumu; Miller, James; Islam, Zhahirul; Hartung, Hans Peter; Chavada, Govindsinh; Jacobs, Bart C.; Hughes, Richard; Doorn, Pieter A. van

doi:10.1136/jnnp-2019-321496

Cited by 44 publications

(22 citation statements)

References 25 publications

(32 reference statements)

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“…Some patients may nonetheless continue to deteriorate or experience fluctuations of symptoms after the initial dose, necessitating the consideration of a second course of IVIg administration ( Hughes et al, 2007 ; Verboon et al, 2017 ). The benefit of a second course of IVIg has yet to be corroborated ( Walgaard et al, 2018 ; Verboon et al, 2020 ), although a minor increase in the serum IgG level was proposed as a predictor for poor outcomes after a single dose of IVIg ( Kuitwaard et al, 2009 ). IVIg is correlated with adverse events including stroke, hemolytic anemia, transfusion-related acute lung injury (TRALI), aseptic meningitis, and venous embolism ( Koichihara et al, 2008 ; Nguyen et al, 2014 ; Stetefeld et al, 2014 ; Baudel et al, 2020 ) ( Table 2 ).…”

Section: Canonical and Emerging Immunotherapies Of Guillain–barré Syndromementioning

confidence: 99%

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Shang

Feng

et al. 2021

Front. Pharmacol.

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Guillain–Barré syndrome (GBS) is an acute polyneuropathy mostly characterized by acute flaccid paralysis with or without sensory/autonomous nerve dysfunction. Current immuno therapies including intravenous immunoglobulin (IVIg), plasma exchange (PE), and newly developed biological drugs benefit patients by alleviating hyperreactive immune responses. Up to 30% of patients develop respiratory failure during hospitalization and require mechanical ventilation and intensive care. Immunotherapies, mechanical ventilation, supportive care, and complication management during the intensive care unit (ICU) stay are equally emphasized. The most important aspect of intensive care and treatment of severe GBS, that is, mechanical ventilation, has been extensively reviewed elsewhere. In contrast to immunotherapies, care and treatment of GBS in the ICU setting are largely empirical. In this review, we intend to stress the importance of intensive care and treatment, other than mechanical ventilation in patients with severe GBS. We summarize the up-to-date knowledge of pharmacological therapies and ICU management of patients with severe GBS. We aim to answer some key clinical questions related to the management of severe GBS patients including but not limited to: Is IVIg better than PE or vice versa? Whether combinations of immune therapies benefit more? How about the emerging therapies promising for GBS? When to perform tracheal intubation or tracheostomy? How to provide multidisciplinary supportive care for severe cases? How to avert life-threatening complications in severe cases?

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Section: Canonical and Emerging Immunotherapies Of Guillain–barré Syndromementioning

confidence: 99%

Intensive Care and Treatment of Severe Guillain–Barré Syndrome

Shang

Feng

et al. 2021

Front. Pharmacol.

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“…43 The same results were also previously reported by an observational study by Verboon et al which showed that second IVIG doses could not significantly enhance the prognosis of poor GBS. 44 Although previous investigations have approached the efficacy of some other management modalities, none of these approaches have been proven to be significantly efficacious as compared to plasma exchange and IVIG. 45…”

Section: Managementmentioning

confidence: 99%

Guillain–Barré syndrome: pathophysiology, etiology, causes, and treatment

Rahman¹,

Bauthman

Alanazi

et al. 2021

Int J Community Med Public Health

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Guillain–Barré syndrome (GBS) is a polyradiculoneuropathy autoimmune disease that is characterized by significant inflammation that affects the peripheral nervous system in a rapidly progressive pattern that is mainly clinically presented by muscle weakness. The present literature review aims to broadly discuss GBS: etiology, pathophysiology and management in order to gain an understading of the existing studies that are relevant to this literature review. Among the reported antibodies, anti-GM1 and anti-GQ1B have been reported to be responsible for attacking and damaging either the neuromuscular junctions or peripheral nerves. Moreover, it has been found that the anti-GD1a antibodies in patients bind to the neuromuscular junction and also bind to the nodes of Ranvier of the peripheral nerves and the paranodal myelin of the affected nerves. Reports have shown that this disease is identified as special forms of neuropathies that develop in immune-mediated, post-infection sequelae. Furthermore, in another study it was reported that Molecular mimicry has been previously reported to significantly correlate with the development of the disease as it was investigated in animal models. In addition, Campylobacter jejuni, a pathogen that causes gastrointestinal infections has been previously reported to predispose to the development of GBS in humans. However, scientists have found that plasma exchange and intravenous immunoglobulins (IVIG) remain the most significant and efficacious factors in managing the disease. Nevertheless, recent trials have investigated other approaches that are less efficacious and can lead to serious adverse events and complications.

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“…Complications from a second immunoglobulin course were not reported in the Verboon and colleagues’ study, but risks from venous and arterial thrombosis are likely to be greater with higher doses of IVIg. The definitive answer to the question of the efficacy of a second immunoglobulin dose for GBS will have to await the results of the randomised controlled trial recently completed in the Netherlands 17…”

Section: This Editorial Comments On a Large Prospective Study Of Gbs mentioning

confidence: 99%