Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barré syndrome

Hind A. Beydoun; May A. Beydoun; Sharmin Hossain; Alan B. Zonderman; Shaker M. Eid

doi:10.1002/mus.26831

Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barré syndrome

Hind A. Beydoun, May A. Beydoun, Sharmin Hossain, Alan B. Zonderman, Shaker M. Eid

School of Medicine

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS). Methods: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002–2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. Results: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. Conclusions: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.

Original language	English (US)
Pages (from-to)	608-615
Number of pages	8
Journal	Muscle and Nerve
Volume	61
Issue number	5
DOIs	https://doi.org/10.1002/mus.26831
State	Published - May 1 2020

Keywords

Guillain-Barré syndrome
autoimmunity
healthcare utilization
immunotherapy
intravenous immunoglobulin
therapeutic plasma exchange

ASJC Scopus subject areas

Physiology
Clinical Neurology
Cellular and Molecular Neuroscience
Physiology (medical)

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10.1002/mus.26831

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title = "Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barr{\'e} syndrome",

abstract = "Background: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barr{\'e} syndrome (GBS). Methods: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002–2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. Results: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. Conclusions: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.",

keywords = "Guillain-Barr{\'e} syndrome, autoimmunity, healthcare utilization, immunotherapy, intravenous immunoglobulin, therapeutic plasma exchange",

author = "Beydoun, {Hind A.} and Beydoun, {May A.} and Sharmin Hossain and Zonderman, {Alan B.} and Eid, {Shaker M.}",

note = "Funding Information: The manuscript was supported in part by the Intramural Research Program at the National Institute on Aging and Johns Hopkins University School of Medicine. Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or the U.S. Government. Publisher Copyright: {\textcopyright} 2020 Wiley Periodicals, Inc.",

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AU - Hossain, Sharmin

AU - Zonderman, Alan B.

AU - Eid, Shaker M.

N1 - Funding Information: The manuscript was supported in part by the Intramural Research Program at the National Institute on Aging and Johns Hopkins University School of Medicine. Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or the U.S. Government. Publisher Copyright: © 2020 Wiley Periodicals, Inc.

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Background: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS). Methods: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002–2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. Results: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. Conclusions: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.

AB - Background: We compared outcomes of therapeutic plasma exchange (TPE) vs intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré syndrome (GBS). Methods: In a retrospective cohort study of 6642 records (2637 TPE and 4005 IVIG) from the 2002–2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges, and in-hospital death, with regression modeling using risk adjustment and propensity scoring to control for confounders. Results: Compared with those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by approximately 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment, or matching. Conclusions: TPE may be associated with poorer healthcare utilization outcomes vs IVIG, although confounding by indication could not be ascertained.

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KW - intravenous immunoglobulin

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Nationwide study of therapeutic plasma exchange vs intravenous immunoglobulin in Guillain-Barré syndrome

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