Assessing the impact of a second IVIG dose on patients with Guillain-Barré Syndrome: A synthesis without meta-analysis (SWiM).

Abstract

Background and aim: Guillain-Barré Syndrome (GBS) is a severe neurological disorder in which the immune system attacks the peripheral nervous system, leading to acute flaccid paralysis. The conventional treatment involves intravenous immunoglobulin (IVIG), yet the efficacy of a second IVIG dose remains uncertain. This systematic review aims to evaluate the clinical outcomes of administering a second dose of IVIG in GBS patients.

Methods: The review was registered in the PROSPERO database (CRD42024557465) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Databases including EBSCO, MEDLINE, CINAHL, and SCOPUS were searched from database inception until June 2024, using a combination of relevant keywords. Only English-language studies were included. Quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. In total, 89 abstracts were initially screened, 20 full-text articles were reviewed, and 10 studies met the inclusion criteria for final evaluation.

Results: The review included 10 studies with 94 patients across all included studies (31 female, 63 male). This review includes two clinical trials, six case studies, and two case report series, conducted across Europe and Asia. The studies evaluated the clinical outcomes of a second IVIG dose in GBS patients in various healthcare settings, such as emergency rooms, medical departments, and intensive care units. Most of these studies reported significant clinical improvements in motor symptoms and successful weaning from mechanical ventilation following the administration of a second IVIG dose. Eighty percent of the studies included patients on mechanical ventilation, with a standard IVIG dose of 0.4 g/kg reported in 60% of studies. Half of the studies administered the second IVIG dose 2 weeks after the first. Seventy percent of the studies reported clinical motor improvement following the second IVIG dose, with half indicating successful weaning from mechanical ventilation. Evaluation methods varied, with cerebrospinal fluid protein testing (60%) and nerve conduction studies (50%) being the most common. A smaller proportion of studies assessed GMI/GDIA antibodies, immunoglobulin G (IgG) levels, or conducted electrophysiological studies. The findings demonstrate the potential effectiveness of a second IVIG dose in improving motor outcomes and reducing ventilator dependency in GBS patients.

Conclusion: The findings suggest that a second dose of IVIG may enhance clinical outcomes in GBS patients, particularly in improving motor functions and facilitating weaning from mechanical ventilation. However, further prospective randomized trials are essential to validate these results and improve treatment protocols.