Sequential treatment of Guillain-Barré syndrome with extracorporeal elimination and intravenous immunoglobulin

Haupt, Walter F.; Rosenow, Felix; Ven, C. van der; Borberg, H.; Pawlik, G.

doi:10.1016/0022-510x(95)00357-8

Cited by 47 publications

(17 citation statements)

References 22 publications

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“…In a prospective trial with a block sequential design, there were no differences in outcome between 11 patients treated with PE and 13 treated with immunoabsorption. 26 Conclusion. There is only limited class IV evidence from one small nonrandomized unblinded study.…”

Section: Immunoabsorptionmentioning

confidence: 99%

“…7 A class III study comparing immunoabsorption with tryptophan polyvinyl exchange alone and immunoabsorption followed by IVIg in 34 participants showed no significant difference between these regimens after 1 and 12 months. 26 Conclusion. Sequential treatment with PE followed by IVIg does not have a superior effect to either treatment given alone (class I evidence).…”

Section: 29mentioning

confidence: 99%

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Practice parameter: Immunotherapy for Guillain–Barré syndrome

et al. 2003

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Abstract-Objective:To provide an evidence-based statement to guide physicians in the management of Guillain-Barré syndrome (GBS). Methods: Literature search and derivation of evidence-based statements concerning the use of immunotherapy were performed. Results: Treatment with plasma exchange (PE) or IV immunoglobulin (IVIg) hastens recovery from GBS. Combining the two treatments is not beneficial. Steroid treatment given alone is not beneficial. Recommendations: 1) PE is recommended for nonambulant adult patients with GBS who seek treatment within 4 weeks of the onset of neuropathic symptoms. PE should also be considered for ambulant patients examined within 2 weeks of the onset of neuropathic symptoms; 2) IVIg is recommended for nonambulant adult patients with GBS within 2 or possibly 4 weeks of the onset of neuropathic symptoms. The effects of PE and IVIg are equivalent; 3) Corticosteroids are not recommended for the management of GBS; 4) Sequential treatment with PE followed by IVIg, or immunoabsorption followed by IVIg is not recommended for patients with GBS; and 5) PE and IVIg are treatment options for children with severe GBS. NEUROLOGY 2003;61:736 -740 Guillain-Barré syndrome (GBS) affects between 1 and 4 per 100,000 of the population annually throughout the world, 1 causing respiratory failure requiring ventilation in approximately 25%, death in 4 to 15%, 2-6 persistent disability in approximately 20%, 7 and persistent fatigue in 67%. 8 The costs in the United States have been estimated as $110,000 for direct health care and $360,000 in lost productivity per patient. 9 This practice parameter classifies the relevant evidence on immunotherapy to provide evidence-based recommendations for the management of GBS. 10Evidence review. A search of MEDLINE from 1966 and of the Cochrane library was performed in March 2002. "Polyradiculoneuritis" was limited by "human" and cross-referenced with "therapy." The search results were reviewed for each question by at least two members of the practice parameter group and supplemented from the reference lists in the articles retrieved and the personal reference lists of the members of the practice parameter group. Those titles representing relevant randomized controlled trials (RCTs) are included in the tables on the Neurology Web site for this article (www.neurology.org). Recommendations were graded according to the levels established by the AAN Quality Standards Subcommittee at the inception of this project (table).

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Section: Immunoabsorptionmentioning

confidence: 99%

Section: 29mentioning

confidence: 99%

Practice parameter: Immunotherapy for Guillain–Barré syndrome

et al. 2003

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“…However, treatment volumes with the tryptophan adsorber were comparatively large in this study and cannot be taken as obligatory. In other autoimmune neuropathies including myasthenic crisis and GBS, PE and tryptophan IA were already effective with plasma treatment volumes of 1–2.5 l [24,25,27,40,44,45]. In patients treated with long-term IA, a weekly treatment volume of 2.5 l seems to be adequate.…”

Section: Discussionmentioning

confidence: 99%

“…In Germany, selective IA has been increasingly used in autoimmune-related neurological diseases due to its equivalent efficacy and advantageous safety profile [23]. It had been shown that IA is an effective treatment for GBS patients [23,24,25]. However, although IA therapy has been used as a treatment option for CIDP for a number of years, the efficacy of IA treatment for CIDP had not been analyzed in a larger number of patients yet, and only few case reports are found in the literature [38,39,40].…”

Section: Discussionmentioning

confidence: 99%

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Immunoadsorption in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy with Unsatisfactory Response to First-Line Treatment

Galldiks¹,

Burghaus²,

Dohmen³

et al. 2011

Eur Neurol

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Background/Aims: First-line treatment options for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are corticosteroids, intravenous immunoglobulin, and plasma exchange. In a significant number of patients, first-line therapy fails, and long-term maintenance treatment still remains a therapeutic challenge. Immunoadsorption (IA) may be an alternative to classical plasma exchange in the therapy of immune-mediated neurologic diseases. The aim of this investigation was to evaluate efficacy and safety of IA in patients with CIDP with unsatisfactory response to first-line treatment options. Methods: CIDP patients received adjunct IA treatment using tryptophan-immune adsorbers. The inflammatory neuropathy cause and treatment disability (INCAT) score was used to grade disability and monitor treatment effects. Results: In total, 14 CIDP patients were analyzed. Ten patients were treated in hospital. After one IA treatment series, the INCAT score decreased significantly in all 10 patients. Four of these 14 patients were treated in outpatient clinics using long-term maintenance IA with 1–2 treatments per week. In these 4 patients, effects of long-term maintenance IA resulted in an improvement of overall disability. In all patients, IA was safe, well tolerated, and no severe adverse effects occurred. Conclusion: IA could be an effective and safe option for CIDP patients with unsatisfactory response to first-line treatment options and for long-term maintenance treatment.

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Experience of double filtration plasmapheresis in the treatment of Guillain-Barr� syndrome

1999

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Therapeutic plasma exchange (TPE) is a standard treatment in Guillain‐Barré syndrome. TPE may require exogenous fluid for replacement of plasma and, depending on the equipment used, varying extracorporeal volumes. Potential adverse effects include allergic reaction, infection, and hypotension. From September 1993 to December 1997, we treated 16 patients with Guillain‐Barré syndrome by a newly developed method of automated double filtration plasmapheresis (DFPP). Patients (ten males and six females, age ranged from 16 to 73) suffering from acute ascending motor weakness and fulfilling the diagnostic criteria for GBS were chosen for DFPP. Each patient received at least five sessions of apheresis in 7 to 10 days and approximately 2.5 to 3.0 L of plasma was treated in each session. Patients were evaluated by disability grade according to a Hughes scale. The mean grade of disability was 3.62 at treatment and improved to 2.37 four weeks after the start of DFPP. The median time to grade 2 (walk without support) was 19 days. There were five patients (41.6%) in need of respirator support. The median time to weaning off the respirator was 9 days. Only two patients (12.5%) could not reach grade 2 at the end of 6 months. Our results were comparable to previously published results of TPE. We conclude that DFPP may be as effective as TPE in the treatment of GBS. J. Clin. Apheresis 14:126–129, 1999. © 1999 Wiley‐Liss, Inc.

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Sequential treatment of Guillain-Barré syndrome with extracorporeal elimination and intravenous immunoglobulin

Cited by 47 publications

References 22 publications

Practice parameter: Immunotherapy for Guillain–Barré syndrome

Practice parameter: Immunotherapy for Guillain–Barré syndrome

Immunoadsorption in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy with Unsatisfactory Response to First-Line Treatment

Experience of double filtration plasmapheresis in the treatment of Guillain-Barr� syndrome

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