Response to IVIg in Guillaine-Barre syndrome was first reported in 1988. not many trials are available on comparison of IVIg with supportive management. Three significant studies have been conducted for comparison of IVIg with plasma exchange (PE). One study provided randomized selection of GBS patients with either PE or IVIg within 14 days of the appearance of the symptoms. An over all quicker recovery in patients undergoing IVIg treatment was seen.
It was concluded that IVIg may be as effective as PE and visible efficacy trend towards the IVIg treatment may be due to variations of baseline variables. Another study conducted a similar study and found IVIg to be as effective in GBS treatment as PE. No speedier recovery was seen in patients who underwent IVIg treatment. A Meta analysis conducted on studies comparing IVIg with PE gave 398 patients. The IVIg was assessed on the basis of changes in the disability scale, as was used in older studies.
The Meta Analysis concluded that “there was no significant difference between IVIg and PE in change of disability grade or in time to walk unaided, mortality, or proportion of patients unable to walk at one year. ” (Winer, J. B 2002). It has also been noted that the relapse rate is higher in patients who undergo IVIg when compared with Plasma exchange. Corticosteroid: Corticosteroid drugs have a strong anti inflammatory effect. This knowledge leads may lead one to believe that corticosteroids have help in reducing and limiting the nerve damage in case of GBS.
Many trials have been conducted to evaluate the effectiveness of corticosteroids in the treatment of GBS. From the six trials which had 587 participants, the overall results showed no difference in disability grade, in patients treated with corticosteroids and non corticosteroids. Four trials were conducted with 120 participants using oral corticosteroids. The results showed significantly less improvement in patients who had undergone oral corticosteroids treatment when compared with those who underwent non steroidal treatment for GBS.
In two large trials which compared intravenous corticosteroids compared with placebo. It was shown that they hasten recovery when given with IVIg. The study review concluded that “oral corticosteroids may delay recovery from Guillaine-Barre syndrome whereas intravenous corticosteroids may hasten recovery when given with intravenous immunoglobulin but do not affect the long-term outcome. ” (Hughes RAC, 1999) Interferon: Certain new treatment modalities have come into light which may prove to be of superior efficacy when compared with plasma exchange and IVIg.
These according to researchers include use of Interferon beta, Cerebrospinal fluid infiltration and administration of nerve growth factor to hasten nerve repair and regeneration. The most promising future treatment according to researchers may be the use of interferon beta. It has the capacity to reduce the adhesion process as well as transmigration of lymphocytes, hence potentially providing us with a beneficial therapeutic effect. (Gersh, H. , 2007). In view of the potential therapeutic effects of interferon usage, a study was conducted on 19 non ambulant GBS patients.
This double blind study compared randomized patients receiving either interferon beta 1a or placebos in addition to IVIg. The treatment continued for up to 24 weeks. It was noted that combining IVIg with interferon had no additional significant effect on the rate of recovery in the patients who received IVIg when compared with placebo administered patients. (Pritchard, J, 2003). Other immunomodulatory and cytotoxic drugs have also been used in trials with no added benefit in recovery process. A cross over trial of interferon on GBS patients revealed that interferon was of no extra benefit. (Hughes, R. A. C. , 2002).