Review: plasma exchange or intravenous immunoglobulin reduces disability in the Guillain-Barre syndrome.

M a i n r e s u l t s Plasma exchange: At 4 weeks, more patients who received plasma exchange than supportive care improved by ≥ 1 disability grade (Table). Mean improvement in disability grade was greater in the plasma exchange group than in the supportive care group (4 RCTs, n = 585) (weighted mean difference [WMD] −0.89, 95% CI −1.14 to −0.63). The number of patients still on a ventilator 4 weeks after randomization was lower in the plasma exchange group than in the supportive care group (Table). At 1 year, more patients in the plasma exchange group than in the supportive care group had recovered full muscle strength (Table). IgIV: Meta-analysis of 3 RCTs (n = 398) that compared IgIV with plasma exchange showed no difference between groups for improvement in GBS-related disability at 4 weeks (WMD 0.11, CI −0.14 to 0.37). Meta-analysis of 2 RCTs (n = 533) showed that fewer patients in the IgIV group than in the plasma exchange group discontinued the study (relative risk 0.11, CI 0.04 to 0.32). Steroids: 6 RCTs compared any form of corticosteroid or adrenocorticotrophic hormone with no steroid or placebo. Metaanalysis of 3 RCTs (n = 296) showed that the groups did not differ for improvement in disability grade 4 weeks after randomization (WMD −0.06, CI −0.32 to 0.19).