Intravenous immunoglobulins versus plasma exchange in the treatment of Guillain-Barré syndrome

Abstract

Introduction: Annually, Guillain-Barre syndrome (GBS) affects one to four cases/100,000. Intravenous immunoglobulins (IVIg) and plasma exchange (PE) are the main treatment in this disease. The purpose of this study is to compare the efficacy of IVIg versus PE in the treatment of GBS in a medical ICU. Methods: This is a prospective, monocentric, nonrandomized study, realized in the medical ICU of the Ibn Rochd university hospital of Casablanca, during 5 years (2002 to 2006). We included all patients with GBS who required mechanical ventilation (MV). An electromyogram was realized in all patients and found axonal demyelinization. We defined two groups: group 1 (group treated by IVIg: 0.4 g/kg/day during 5 days) and group 2 (group treated by PE: 4 PEs during 10 to 14 days). We collected demographic characteristics, clinical and therapeutic aspects and outcome. We evaluated the beginning of motility recuperation and MV weaning essentially. The quantitative variables are expressed as the average or median (plus or minus) standard deviation, and the qualitative variables by percentage. The univariate analysis was based on the Pearson chi-square test or the Fisher test for the qualitative variables and the Student test for the quantitative ones. P <0.05 is considered significant. The statistical analysis was based on SPSS 11.0 for Windows. Results: Forty-one patients (21 in group 1 and 20 in group 2) were enrolled. The mean age was 37 (plus or minus) 9 years, with a masculine predominance (75.4%). The mean length of hospitalization was 32 days. The length of hospitalization of group 1 was less than that of group 2 (P = 0.02). The weaning of MV was more precocious in the patients of group 1 than those of group 2 (P = 0.01). Also, the beginning of motility recuperation was more precocious in group 1 than in group 2 (P = 0.001). Conclusions: Although the results of the literature are not conclusive, our work - of which the most important slant is the absence of randomization - reveals that there is a meaningful difference for MV weaning between the group receiving IVIg in relation to the PE group. These encouraging results would merit confirmation by controlled and randomized works.