Review: Plasma exchange or intravenous immunoglobulin reduces disability in the Guillain-Barré syndrome: COMMENTARY

Bleck, Thomas P.
May 2004
ACP Journal Club;May/Jun2004, Vol. 140 Issue 3, p76
Academic Journal
The value of treating patients with Guillain-Barr syndrome (GBS) with plasma exchange or intravenous immunoglobulin (IgIV) is beyond dispute. However, data from randomized clinical trials do not help a clinician choose between the agents for individual patients. This choice should consider the probable adverse effects associated with each treatment. Authors usually favor plasma exchange for patients in whom hyperviscosity from IgIV is a potential problem. However, IgIV may be a better choice when central venous access for plasma exchange is problematic. Some patients finish a course of treatment without improvement, or their disease continues to progress. It is tempting to apply another treatment in this circumstance, but clinical trials do not suggest any. No clear benefit was observed in a trial that evaluated plasma exchange followed by IgIV, although an insignificant difference between plasma exchange or IgIV alone and their combination sometimes leads to its use in desperation. The somewhat illogical sequence of IgIV followed by plasma exchange has not been tested.


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