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

Christine Verboon, Bianca Van Den Berg, David Cornblath, Esmee Venema, Kenneth C. Gorson, Michael P. Lunn, Hester Lingsma, Peter Van Den Bergh, Thomas Harbo, Kathleen Bateman, Yann Pereon, Søren H. Sindrup, Susumu Kusunoki, James Miller, Zhahirul Islam, Hans Peter Hartung, Govindsinh Chavada, Bart C. Jacobs, Richard A.C. Hughes, Pieter A. Van Doorn

Research output: Contribution to journalArticle

Abstract

Objective: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. Methods: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. Results: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. Conclusions: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

Original languageEnglish (US)
JournalJournal of Neurology, Neurosurgery and Psychiatry
DOIs
StateAccepted/In press - Jan 1 2019

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Intravenous Immunoglobulins
Observational Studies
Motivation

Keywords

  • Guillain-Barré syndrome
  • poor prognosis
  • second IVIg course
  • treatment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Second IVIg course in Guillain-Barré syndrome with poor prognosis : The non-randomised ISID study. / Verboon, Christine; Van Den Berg, Bianca; Cornblath, David; Venema, Esmee; Gorson, Kenneth C.; Lunn, Michael P.; Lingsma, Hester; Van Den Bergh, Peter; Harbo, Thomas; Bateman, Kathleen; Pereon, Yann; Sindrup, Søren H.; Kusunoki, Susumu; Miller, James; Islam, Zhahirul; Hartung, Hans Peter; Chavada, Govindsinh; Jacobs, Bart C.; Hughes, Richard A.C.; Van Doorn, Pieter A.

In: Journal of Neurology, Neurosurgery and Psychiatry, 01.01.2019.

Research output: Contribution to journalArticle

Verboon, C, Van Den Berg, B, Cornblath, D, Venema, E, Gorson, KC, Lunn, MP, Lingsma, H, Van Den Bergh, P, Harbo, T, Bateman, K, Pereon, Y, Sindrup, SH, Kusunoki, S, Miller, J, Islam, Z, Hartung, HP, Chavada, G, Jacobs, BC, Hughes, RAC & Van Doorn, PA 2019, 'Second IVIg course in Guillain-Barré syndrome with poor prognosis: The non-randomised ISID study', Journal of Neurology, Neurosurgery and Psychiatry. https://doi.org/10.1136/jnnp-2019-321496
Verboon, Christine ; Van Den Berg, Bianca ; Cornblath, David ; Venema, Esmee ; Gorson, Kenneth C. ; Lunn, Michael P. ; Lingsma, Hester ; Van Den Bergh, Peter ; Harbo, Thomas ; Bateman, Kathleen ; Pereon, Yann ; Sindrup, Søren H. ; Kusunoki, Susumu ; Miller, James ; Islam, Zhahirul ; Hartung, Hans Peter ; Chavada, Govindsinh ; Jacobs, Bart C. ; Hughes, Richard A.C. ; Van Doorn, Pieter A. / Second IVIg course in Guillain-Barré syndrome with poor prognosis : The non-randomised ISID study. In: Journal of Neurology, Neurosurgery and Psychiatry. 2019.
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abstract = "Objective: To compare disease course in patients with Guillain-Barr{\'e} syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. Methods: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. Results: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95{\%}CI 0.16 to 3.04) for the early group and 0.66 (95{\%}CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. Conclusions: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.",
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T1 - Second IVIg course in Guillain-Barré syndrome with poor prognosis

T2 - The non-randomised ISID study

AU - Verboon, Christine

AU - Van Den Berg, Bianca

AU - Cornblath, David

AU - Venema, Esmee

AU - Gorson, Kenneth C.

AU - Lunn, Michael P.

AU - Lingsma, Hester

AU - Van Den Bergh, Peter

AU - Harbo, Thomas

AU - Bateman, Kathleen

AU - Pereon, Yann

AU - Sindrup, Søren H.

AU - Kusunoki, Susumu

AU - Miller, James

AU - Islam, Zhahirul

AU - Hartung, Hans Peter

AU - Chavada, Govindsinh

AU - Jacobs, Bart C.

AU - Hughes, Richard A.C.

AU - Van Doorn, Pieter A.

PY - 2019/1/1

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N2 - Objective: To compare disease course in patients with Guillain-Barré syndrome (GBS) with a poor prognosis who were treated with one or with two intravenous immunoglobulin (IVIg) courses. Methods: From the International GBS Outcome Study, we selected patients whose modified Erasmus GBS Outcome Score at week 1 predicted a poor prognosis. We compared those treated with one IVIg course to those treated with two IVIg courses. The primary endpoint, the GBS disability scale at 4 weeks, was assessed with multivariable ordinal regression. Results: Of 237 eligible patients, 199 patients received a single IVIg course. Twenty patients received an 'early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a 'late' second IVIg course (2-4 weeks after start of IVIg). At baseline and 1 week, those receiving two IVIg courses were more disabled than those receiving one course. Compared with the one course group, the adjusted OR for a better GBS disability score at 4 weeks was 0.70 (95%CI 0.16 to 3.04) for the early group and 0.66 (95%CI 0.18 to 2.50) for the late group. The secondary endpoints were not in favour of a second IVIg course. Conclusions: This observational study did not show better outcomes after a second IVIg course in GBS with poor prognosis. The study was limited by small numbers and baseline imbalances. Lack of improvement was likely an incentive to start a second IVIg course. A prospective randomised trial is needed to evaluate whether a second IVIg course improves outcome in GBS.

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