Second IVIg course in Guillain-Barré syndrome with poor prognosis. The non-randomised ISID study

Verboon, C.; Van Den Berg, B.; Cornblath, D. R.; Venema, E.; Gorson, K. C.; Lunn, M. P.; Lingsma, H.; Van Den Bergh, P.; Harbo, T.; Bateman, K.; Pereon, Y.; Sindrup, So. H.; Kusunoki, S.; Miller, J.; Islam, Z.; Hartung, H. -P.; Chavada, G.; Jacobs, B. C.; Hughes, R. A. C.; Addington, Van Doorn P. A. J. M.; MD (University of Virginia,; USA), Charlottesville; On October 7, S. Consortia. Protected By Copyright.; Downloaded From 8 Verboon C, 2019 at Uppsala Universitet BIBSAM http://jnnp. bmj. com/ J Neurol Neurosurg Psychiatry: first published as 10. 1136/jnnp-2019-321496 on 5 October 2019.; J Neurol Neurosurg Psychiatry 2019, Et Al.; 1136/jnnp-2019-321496 Neuromuscular Ajroud-Driss, 0:1–9. Doi:10.; MD (Northwestern University Feinberg,; USA), Chicago; Antonini, G.; MD (Mental Health and Sensory Organs (NESMOS),; University, Sapienza; Hospital, Sant’Andrea; Italy), Rome; Attarian, S.; Md,; PhD (CHU Timone,; France), Marseille; Barroso, F. A.; MD (Instituto de Investigaciones Neurológicas Raúl Carrea,; Fleni,; Aires, Buenos; Argentina),; Benedetti, L.; Md,; PhD (Ospedale Sant’ Andrea La Spezia,; Spezia, La; Italy),; Bertorini, T. E.; MD (The University of Tennessee Health Science Center (UTHSC),; USA), Memphis; Brannagan, T. H.; MD (Columbia University,; New York City,; USA),; Briani, C.; MD (University of Padova,; Italy), Padova; Bhavaraju-Sanka, R.; MD (University Hospital/University of Texas Health Science Center,; San Antonio Texas,; USA),; Butterworth, S.; MD (Pinderfields Hospital,; UK), Wakefield; Casasnovas, C.; Md,; Ciberer, PhD (Bellvitge University Hospital – IDIBELL Neurometabolic Diseases Group.; Spain), Barcelona; Cavaletti, G.; MD (University Milano-Bicocca,; Italy), Monza; Chen, S.; Md,; (Rutgers, Phd; Robert Wood Johnson University Hospital,; Brunswick, New; USA),; Claeys, K. G.; Md,; University Hospitals Leuven, PhD (1.; Belgium, Leuven; Ku Leuven, 2.; Belgium), Leuven; Cosgrove, J. S.; MD (Leeds General Infirmary,; UK), Leeds; Davidson, A.; MD (University of Glasgow,; UK), Glasgow; Dardiotis, E.; MD (University of Thessaly,; Hospital Of Larissa,; Greece), Larissa; Dornonville De La Cour, C.; MD (National Hospital Copenhagen,; Denmark), Copenhagen; Faber, C. G.; Md,; PhD (Maastricht University Medical Centre,; Maastricht,; Netherlands), The; Feasby, T. E.; MD (University of Calgary,; Canada), Calgary; Fujioka, T.; MD (Toho University Medical Center,; Japan), Tokyo; Galassi, G.; MD (University Hospital of Modena,; Italy), Modena; Gilchrist, J. M.; MD (Soulthern Illinois University School of Medicine,; USA), Springfield; Goyal, N. A.; MD (University of California,; USA), Irvine; Granit, V.; MD (Montefiore Medical,; Center,; York, New; USA),; Gutiérrez-Gutiérrez, G.; MD (Hospital Universitario Infanta Sofia,; Sebastian, San; Spain),; Hadden, R. D. M.; Md,; PhD (King’s College Hospital,; UK), London; Holt, J. K. L.; Phd,; FRCP (The Walton Centre,; UK), Liverpool; Htut, M.; George’S Hospital, MD (St.; UK), London; Jericó Pascual, I.; Md,; PhD (Complejo Hospitalario de Navarra,; Spain), Pamplona; Karafiath, S.; MD (University of Utah School of Medicine,; Salt Lake City,; USA),; Katzberg, H. D.; MD (University of Toronto,; Canada), Toronto; Kiers, L.; MD (University of Melbourne,; Royal Melbourne Hospital,; Australia), Parkville; Kieseier, B. C.; MD (Heinrich Heine University,; Germany), Düsseldorf; Kimpinski, K.; MD (University Hospital,; London-Ontario, Lhsc; Canada),; Kuwabara, S.; Md,; PhD (Chiba University,; Japan), Chiba; Kwan, J. Y.; MD (University of Maryland School of Medicine,; USA), Baltimore; Ladha, S. S.; MD (Barrow Neurology Clinics,; Arizona, Phoenix; USA),; Lawson, V.; MD (Wexner Medical Center at The Ohio State University,; USA), Columbus; Lehmann, H.; Md,; PhD (University Hospital of Cologne,; Köln, Universitätsklinikum; Germany), Cologne; Manji, H.; Md,; FRCP (Ipswich Hospital,; UK), Ipswich; Marfia, G. A.; MD (Neurological Clinic,; Policlinico Tor Vergata,; Italy), Rome; Márquez Infante, C.; MD (Hospital Universitario Virgen del Rocio,; Spain), Seville; Mattiazzi, M. G.; MD (Hospital Militar Central,; Aires, Buenos; Argentina),; Mcdermott, C. J.; MD (Royal Hallamshire Hospital,; Clinical, Nihr; UK), Sheffield; Monges, M. S.; Garrahan, MD (Hospital de Pediatría J. P.; Aires, Buenos; Argentina),; Morís De La Tassa, G.; MD (Hospital Universitario Central de Asturias,; Spain), Asturias; Nascimbene, C.; Md,; PhD (Luigi Sacco Hospital,; Italy), Milan; Nobile Orazio, E.; Md,; PhD (Milan University,; Humanitas Clinicala And Research Institute Milan,; Italy),; Nowak, R. J.; MD (Yale University School of Medicine,; Haven, New; USA),; Osei-Bonsu (James Cook University Hospital, M.; UK), Middlesbrough; Pardo Fernandez (Hospital Clínico de Santiago, J.; Santiago de Compostela (A Coruña),; Spain),; Querol Gutierrez, L.; Md,; PhD (Hospital de la Santa Creu, I Sant Pau; Universitat Autònoma De Barcelona,; Spain), Barcelona; Reisin (Hospital Britanico, R.; Aires, Buenos; Argentina),; Rinaldi, S.; Mbchb,; Roberts, PhD (University of Oxford R. C.; MD (Addenbrooke’s Hospital Cambridge,; UK), Cambridge; Rojas-Marcos, I.; MD (Hospital Univesitario Reina Sofia,; Spain), Cordoba; Rudnicki, S. A.; MD (University of Arkansas,; USA), Fayetteville; Schenone, A.; Md,; Department Of Neurosciences, PhD (1.; Ophthalmology, Rehabilitation; Genetics and Maternal and Infantile Sciences (DINOGMI),; University Of Genova,; Genova,; Irccs Policlinico San Martino, Italy 2.; Italy), Genova; Sedano Tous, M. J.; MD (Hospital Universitario Marques de Valdecilla,; Cantabria, Santander; Spain),; Shahrizaila, N.; MD (Neurology Unit,; Department Of Medicine,; Faculty Of Medicine,; University Of Malaya,; Malaya),; Sheikh, K.; Md,; PhD (The University of Texas Health Science Center at Houston,; USA), Houston; Silvestri, N. J.; MD (Buffalo General Medical Center,; Buffalo, Ny; USA),; Sommer, C. L.; MD (Universitätsklinikum Würzburg,; Germany), Würzburg; Varrato, J. D.; DO (Lehigh Valley Health Network,; USA), Allentown; Verschuuren, J.; Md,; PhD (Leiden University Medical Centre,; Leiden,; Netherlands), The; Vytopil, M. V.; Md,; Waheed, PhD (Tufts University School of Medicine Lahey Hospital W.; MD (University of Vermont Medical Center,; USA), Burlington; Zhou, L.; Md,; PhD (Icahn School of Medicine at Mount Sinai,; York, New; Badrising, USA). Other collaborators were:U. A.; Md,; PhD (Leiden University Medical Centre,; Leiden,; Netherlands), The; Bella, I. R.; MD (University of Mass Medical School,; USA), Worcester; Bunschoten, C.; Md,; PhD candidate (Erasmus University Medical Centre,; Rotterdam,; Netherlands), The; Bürmann, J.; Md,; Universitätsklinikum Des Saarlandes,; Germany), Homburg; Busby, M.; MD (Leeds General Infirmary,; UK), Bradford; Chao, C. C.; Md,; PhD (National Taiwan University Hospital,; Taiwan), Taipei; Conti, M. E.; MD (University Hospital Clinicas,; Aires, Buenos; Argentina),; Dalakas, M. C.; Thomas Jefferson University, MD (1.; Usa, Philadelphia; National And Kapodistrian University Of Athens, 2.; Greece), Athens; Van Damme, P.; Md,; PhD (University Hospital Leuven,; Belgium), Leuven; Doets, A.; Md,; PhD candidate (Erasmus University Medical Centre,; Rotterdam,; Netherlands), The; Van Dijk, G. W.; MD (Canisius Wilhelmina Hospital,; Nijmegen,; Netherlands), The; Dimachkie, M. M.; MD (University of Kansas Medical Center,; City, Kansas; USA),; Doppler, K.; MD (Universitätsklinikum Würzburg,; Germany), Würzburg; Echaniz-Laguna, A.; MD (Hopital de Hautepierre,; France), Strasbourgh; Eftimov, F.; Md,; PhD (Amsterdam University Medical Centre,; Amsterdam,; Netherlands), The; Fazio, R.; MD (Scientific Institute San Raffaele,; Italy), Milan; Fokke, C.; MD (Gelre Hospital,; Zutphen And Apeldoorn,; Netherlands), The; Fulgenzi, E. A.; MD (Hospital Cesar Milstein Buenos Aires,; Aires, Buenos; Argentina),; Garssen, M. P. J.; Md,; PhD (Jeroen Bosch Hospital,; Hertogenbosch, ’S; Zaltbommel And Drunen,; Netherlands), The; Gijsbers, C. J.; MD (Vlietland Hospital,; Schiedam,; Netherlands), The; Gilhuis, J.; Md,; PhD (Reinier de Graaf Gasthuis,; Delft,; Netherlands), The; Grapperon, A.; MD (CHU Timone,; France), Marseille; Hsieh, S. T.; Md,; PhD (National Taiwan University Hospital,; Taiwan), Taipei; Illa, I.; Md,; PhD (Hospital de la Santa Creu, I Sant Pau; Universitat Autònoma De Barcelona,; Spain), Barcelona; Islam, B.; Md,; PhD (International Centre for Diarrhoeal Disease Research,; (icddr, Bangladesh; Dhaka, b); Bangladesh),; Jellema, K.; Md,; PhD (Haaglanden Medisch Centrum,; Hague, The; Netherlands), The; Kaida, K.; Md,; PhD (National Defense Medical College,; Japan), Saitama; Kokubun, N.; MD (Dokkyo Medical University,; Japan), Tochigi; Kolb, N.; MD (University of Vermont,; Burlington, Vt; USA),; Van Koningsveld, R.; Md,; PhD (Elkerliek Hospital,; Helmond And Deurne,; Netherlands), The; Van Der Kooi, A. J.; Md,; PhD (Amsterdam University Medical Centre,; Amsterdam,; Netherlands), The; Kuitwaard, K.; Md,; PhD (Albert Schweitzer Hospital,; Dordrecht,; Netherlands), The; Landschoff Lassen, L.; MD (Glostrup Hospital,; Denmark), Glostrup; Leonhard, S. E.; Md,; PhD candidate (Erasmus University Medical Centre,; Rotterdam,; Netherlands), The; Mandarakas, M.; Md,; PhD (Erasmus University Medical Centre,; Rotterdam,; Netherlands), The; Martinez Hernandez, E.; MD (Institut d’Investigacions Biomèdiques August Pi, i Sunyer (IDIBAPS); Clinic, Hospital; Spain), Barcelona; Mohammad, Q. D.; Md,; PhD (National Institute of Neurosciences and Hospital,; Bangladesh), Dhaka; Pulley, M.; MD (University of Florida,; USA), Jacksonville; Rajabally, Y. A.; Md,; PhD (Queen Elizabeth Hospital,; UK), Birmingham; Reddel, S. W.; Md,; PhD (Concord Repatriation General Hospital,; Australia), Sydney; Van Der Ree, T.; (Westfriesgasthuis, Md; Hoorn,; Netherlands), The; Roodbol, J.; Md,; PhD candidate (Erasmus University Medical Centre,; Rotterdam,; Netherlands), The; Sachs, G. M.; MD (University of Rhode Island,; USA), Providence; Samijn, J. P. A.; Md,; PhD (Maasstad Hospital,; Rotterdam,; Netherlands), The; Santoro, L.; Md,; PhD (University Federico II,; Italy), Napels; Stein, B.; Joseph’S Regional Medical Center, MD (St.; USA), Paterson; Vermeij, F. H.; MD (Franciscus Gasthuis,; Rotterdam,; Netherlands), The; Visser, L. H.; Md,; PhD (Elisabeth-TweeSteden Hospital,; Tilburg And Waalwijk,; Netherlands), The; Willison, H. J.; Md,; PhD (University of Glasgow,; UK), Glasgow; Wirtz, P.; Md,; (HagaZiekenhuis, Phd; Hague, The; Netherlands), The; Zivkovich, S. A.; Md,; PhD (University of Pittsburgh Medical Center,; Pittsburgh, USA).

doi:10.1136/jnnp-2019-321496

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 α early' second IVIg course (1-2 weeks after start of the first IVIg course) and 18 patients a α 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.

Second IVIg course in Guillain-Barré syndrome with poor prognosis. The non-randomised ISID study / C., V., B., V.D.B., D. R., C., E., V., K. C., G., M. P., L., H., L., P., V.D.B., T., H., K., B., Y., P., So. H., S., S., K., J., M., Z., I., H. -P., H., G., C., B. C., J., R. A. C., H., Addington, V.D.P.A.J.M., et al.. - In: JOURNAL OF NEUROLOGY, NEUROSURGERY AND PSYCHIATRY. - ISSN 0022-3050. - 91:2(2020), pp. 1-9. [10.1136/jnnp-2019-321496]