Current treatment practice of Guillain-Barré syndrome

IGOS Consortium

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

Original languageEnglish (US)
Pages (from-to)e59-e76
JournalNeurology
Volume93
Issue number1
DOIs
StatePublished - Jul 2 2019

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Miller Fisher Syndrome
Therapeutics
Plasma Exchange
Intravenous Immunoglobulins
Bangladesh
Treatment Failure
Immunotherapy
Outcome Assessment (Health Care)
Guidelines

ASJC Scopus subject areas

  • Clinical Neurology

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Current treatment practice of Guillain-Barré syndrome. / IGOS Consortium.

In: Neurology, Vol. 93, No. 1, 02.07.2019, p. e59-e76.

Research output: Contribution to journalArticle

IGOS Consortium. / Current treatment practice of Guillain-Barré syndrome. In: Neurology. 2019 ; Vol. 93, No. 1. pp. e59-e76.
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title = "Current treatment practice of Guillain-Barr{\'e} syndrome",
abstract = "OBJECTIVE: To define the current treatment practice of Guillain-Barr{\'e} syndrome (GBS). METHODS: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS: We excluded 88 (7{\%}) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15{\%}) were described separately because 83{\%} were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92{\%}) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97{\%}), mild GBS (126/168, 75{\%}), Miller Fisher syndrome (53/70, 76{\%}), and other variants (33/40, 83{\%}). Of 235 (32{\%}) patients who did not improve after their initial treatment, 82 (35{\%}) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5{\%}) of 1,023 patients, of whom 36 (68{\%}) were re-treated with IVIg or PE. CONCLUSIONS: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.",
author = "{IGOS Consortium} and Christine Verboon and Doets, {Alex Y.} and Giuliana Galassi and Amy Davidson and Waqar Waheed and Yann P{\'e}r{\'e}on and Nortina Shahrizaila and Susumu Kusunoki and Lehmann, {Helmar C.} and Thomas Harbo and Soledad Monges and {Van den Bergh}, Peter and Willison, {Hugh J.} and David Cornblath and Jacobs, {Bart C.}",
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T1 - Current treatment practice of Guillain-Barré syndrome

AU - IGOS Consortium

AU - Verboon, Christine

AU - Doets, Alex Y.

AU - Galassi, Giuliana

AU - Davidson, Amy

AU - Waheed, Waqar

AU - Péréon, Yann

AU - Shahrizaila, Nortina

AU - Kusunoki, Susumu

AU - Lehmann, Helmar C.

AU - Harbo, Thomas

AU - Monges, Soledad

AU - Van den Bergh, Peter

AU - Willison, Hugh J.

AU - Cornblath, David

AU - Jacobs, Bart C.

PY - 2019/7/2

Y1 - 2019/7/2

N2 - OBJECTIVE: To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

AB - OBJECTIVE: To define the current treatment practice of Guillain-Barré syndrome (GBS). METHODS: The study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account. RESULTS: We excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE. CONCLUSIONS: In current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

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