Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis

Zaki, Hany A; Iftikhar, Haris; Najam, Mavia; Masood, Maarij; Al-Marri, Nood Dhafi R; Elgassim, Mohamed Abdelgadir M; Fayed, Mohamed; Shaban, Eman

doi:10.1016/j.ensci.2023.100468

Cited by 9 publications

(4 citation statements)

References 31 publications

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“…The results of our study are consistent with the studies by Zaki et al and Hughes et al in concluding that IVIG and PE have similar curative effects [35,38].…”

Section: Complicationssupporting

confidence: 93%

Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review

Savithri Nandeesha,

Kasagga,

Hawrami

et al. 2024

Cureus

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Guillain-Barré syndrome (GBS) is a rare and debilitating autoimmune disorder that affects the peripheral nervous system. Although the exact etiology of GBS is still unknown, it is thought to be triggered by a preceding gastrointestinal infection in most of the cases. Clinical manifestations include limb weakness, areflexia, and sensory loss that can further progress to neuromuscular paralysis affecting the respiratory, facial, and bulbar functions. Both plasmapheresis (PE) and intravenous immunoglobulin (IVIG) have shown effectiveness in the treatment of GBS, but it is still unclear which treatment approach is superior in terms of therapeutic efficacy. This systematic review acts per Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. For appropriate studies and research, we searched PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Science Direct, and Google Scholar. Screening of articles was performed based on relevance and inclusion and exclusion criteria. To check for bias, we used relevant quality appraisal tools. Initially, we found 2454 articles. After removing duplicates and irrelevant papers, we finalized 31 studies based on titles, abstracts, and reading entire articles. We excluded 14 studies because of poor quality; the remaining 17 papers were included in this review. IVIG is equally efficacious as PE in improving primary outcomes and secondary outcomes. IVIG showed a slight advantage over PE in reducing the need for mechanical ventilation (MV) and hospital stay duration. However, in children, PE demonstrated a slight edge in improving secondary outcomes. PE was associated with a slightly higher risk of adverse events and post-treatment worsening symptoms compared to IVIG. IVIG is considered more user-friendly with a significantly lower patient discontinuation rate than PE. IVIG treatment was found to be significantly more expensive than PE.Categories: Neurology, Internal Medicine Keywords: guillain-barré syndrome (gbs), guillain-barre syndrome (gbs), ivig treatment, therapeutic plasma exchange (tpe), intravenous immunoglobulins (ivig), therapeutic plasmapheresis Review MethodsThis systematic review follows the guidelines and principles of the Preferred. Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 [10]. Search StrategyPubMed, PubMed Central (PMC), Medical Literature Analysis, Retrieval System Online (MEDLINE), Science Direct, and Google Scholar were used exclusively as research databases and search engines to conduct this systemic review. The research utilizes GBS, PE, and IVIG. We used the Boolean terms "AND" and "OR" to combine the relevant concepts with specific keywords, as shown in Table 1.

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“…The results of our study are consistent with the studies by Zaki et al and Hughes et al in concluding that IVIG and PE have similar curative effects [35,38].…”

Section: Complicationssupporting

confidence: 93%

Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review

Savithri Nandeesha,

Kasagga,

Hawrami

et al. 2024

Cureus

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“…When the body is infected with H. pylori , the immune system produces antibodies against H. pylori . Some of these antibodies may misrecognize and attack the nerve tissues due to molecular mimicry, leading to neuroinflammation and demyelination, thus causing GBS [ 27 ]. In addition, it has been shown that H. pylori can express antigens that are structurally similar to the gastric parietal cell H+/K+-ATPase (an autoantigen), which leads to cross-reactivity of gastric T-cells to these two antigens.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of Guillain-Barré Syndrome and Subacute Combined Degeneration of the Spinal Cord Due to Autoimmune Gastritis: A Case Report and Literature Review

Xiang,

Cai

2024

Cureus

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Guillain-Barré syndrome (GBS) and autoimmune gastritis (AIG) are both autoimmune diseases (ADs) that have a low prevalence in China. Both conditions involve the immune system mistakenly attacking the body's own tissues. GBS primarily affects the peripheral nervous system, leading to muscle weakness and paralysis, while AIG targets the stomach lining, causing inflammation and reduced absorption of vital nutrients. Subacute combined degeneration (SCD) of the spinal cord is the most common neurological manifestation of vitamin B12 deficiency. As of yet, there have been no reported cases of patients with GBS and complications of AIG including SCD. We report a case of a 54-year-old male patient who had been experiencing progressive numbness and weakness in his extremities, burning and tingling sensations, a cotton-stepping sensation, and difficulty walking for three weeks. He was admitted to the hospital and underwent an extensive medical workup. Magnetic resonance imaging (MRI) of the cervical spine cord showed abnormal spinal cord signal intensity consistent with typical manifestations of vitamin B12 deficiency. Gastric endoscopy revealed local atrophy of the gastric corpus, and gastric tissue biopsy indicated atrophic gastritis with intestinal metaplasia, consistent with a diagnosis of AIG. Lumbar puncture of cerebrospinal fluid (CSF) results showed albumincytological dissociation, further confirming the diagnosis of GBS. He was treated with intravenous immunoglobulin and methylcobalamin therapy for these conditions and showed significant clinical improvement upon discharge.

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“…Throughout this exploration of advancements in emergency medicine and the challenges in critical care, several key findings have emerged, shedding light on the transformative nature of this field and its implications for patient care and healthcare systems: are essential for delivering high-quality care. [15], [16], [17].…”

Section: A Summary Of Key Findingsmentioning

confidence: 99%

Advancements in Emergency Medicine: Innovations and Challenges in Critical Care

William

2023

Preprint

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Plasma exchange (PE) versus intravenous immunoglobulin (IVIG) for the treatment of Guillain-Barré syndrome (GBS) in patients with severe symptoms: A systematic review and meta-analysis

Cited by 9 publications

References 31 publications

Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review

Treatment Efficacy of Plasmapheresis Versus Intravenous Immunoglobulin in Guillain-Barré Syndrome Management: A Systematic Review

Coexistence of Guillain-Barré Syndrome and Subacute Combined Degeneration of the Spinal Cord Due to Autoimmune Gastritis: A Case Report and Literature Review

Advancements in Emergency Medicine: Innovations and Challenges in Critical Care

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