PT  - JOURNAL ARTICLE
AU  - Christine Verboon
AU  - Bianca van den Berg
AU  - David R Cornblath
AU  - Esmee Venema
AU  - Kenneth C Gorson
AU  - Michael P Lunn
AU  - Hester Lingsma
AU  - Peter Van den Bergh
AU  - Thomas Harbo
AU  - Kathleen Bateman
AU  - Yann Pereon
AU  - Søren H Sindrup
AU  - Susumu Kusunoki
AU  - James Miller
AU  - Zhahirul Islam
AU  - Hans-Peter Hartung
AU  - Govindsinh Chavada
AU  - Bart C Jacobs
AU  - Richard A C Hughes
AU  - Pieter A van Doorn
ED  - ,
TI  - Original research: Second IVIg course in Guillain-Barré syndrome with poor prognosis: the non-randomised ISID study
AID  - 10.1136/jnnp-2019-321496
DP  - 2020 Feb 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 113--121
VI  - 91
IP  - 2
4099  - http://jnnp.bmj.com/content/91/2/113.short
4100  - http://jnnp.bmj.com/content/91/2/113.full
SO  - J Neurol Neurosurg Psychiatry2020 Feb 01; 91
AB  - 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.