TY - JOUR
T1 - Current treatment practice of Guillain-Barré syndrome
AU - IGOS Consortium
AU - Verboon, Christine
AU - Doets, Alex Y.
AU - Galassi, Giuliana
AU - Davidson, Amy
AU - Waheed, Waqar
AU - Péréon, Yann
AU - Shahrizaila, Nortina
AU - Kusunoki, Susumu
AU - Lehmann, Helmar C.
AU - Harbo, Thomas
AU - Monges, Soledad
AU - Van Den Bergh, Peter
AU - Willison, Hugh J.
AU - Cornblath, David R.
AU - Jacobs, Bart C.
AU - Hughes, R. A.C.
AU - Gorson, K. C.
AU - Hartung, H. P.
AU - Van Doorn, P. A.
AU - Van den Berg, B.
AU - Roodbol, J.
AU - Van Woerkom, M.
AU - Reisin, R. C.
AU - Reddel, S. W.
AU - Islam, Z.
AU - Islam, B.
AU - Mohammad, Q. D.
AU - Feasby, T. E.
AU - Dardiotis, E.
AU - Nobile-Orazio, E.
AU - Bateman, K.
AU - Illa, I.
AU - Querol, L.
AU - Hsieh, S. T.
AU - Chavada, G.
AU - Addington, J. M.
AU - Ajroud-Driss, S.
AU - Andersen, H.
AU - Antonini, G.
AU - Ariatti, A.
AU - Attarian, S.
AU - Badrising, U. A.
AU - Barroso, F. A.
AU - Benedetti, L.
AU - Beronio, A.
AU - Bianco, M.
AU - Binda, D.
AU - Briani, C.
AU - Bunschoten, C.
AU - Bhavaraju-Sanka, R.
N1 - Funding Information:
C. Verboon, A. Doets, G. Galassi, A. Davidson, and W. Waheed report no disclosures relevant to the manuscript. Y. Péréon has received research support from CSL Behring and speaker honoraria from LFB, Natus, Pfizer, Novartis, and Boehringer. N. Shahrizaila reports no disclosures relevant to the manuscript. S. Kusunoki reports speech honoraria from Teijin, Japan Blood Product Organization, and Nihon Pharmaceutical, and grants from the Ministry of Health, Labor and Welfare of Japan, The Japan Agency for Medical Research and Development, and Ministry of Education, Culture, Sports, Science and Technology of Japan. H. Lehmann has received personal compensation from Akcea, Alnylam, Celgene, CSL Behring, Grifols, Novartis, and Takeda for consulting services and speaking at scientific symposia. T. Harbo Has received speaker’s honoraria from CSL Behring. S. Monges reports no disclosures relevant to the manuscript. P. Van den Bergh has received honoraria and consultation fees from, or served on the advisory board for, Pfizer, Genzyme, CSL Behring, LFB, Natus, UCB Pharma, and Alnylam; has participated in a company-sponsored speaker’s bureau for Pfizer, LFB, Natus, and CSL Behring; and has received travel assistance, reimbursement of conference registration, and hotel charges for several Peripheral Nerve Society meetings from LFB, Gen-zyme, and CSL Behring. H. Willison serves on the editorial boards of several neurology and neuroimmunology journals, receives research funding the Medical Research Council, Wellcome Trust, and European Union, serves on the Scientific Advisory Board for Annexon Biosciences, has provided scientific or medical advice to Johnson & Johnson, Janssen Vaccines AG, Syntimmune, Hansa Medical, and Minnetronix, and received funding to support meeting costs from Baxalta, CSL Behring, Grifols, Kendrion SpA, LFB Biomedicaments, Octapharma, TEVA, Buhlmann Laboratories, and Syn-timmune. D. Cornblath is a consultant for Acetylon, Alcobra Pharma, Alnylam Pharmaceuticals, Annexon Biosciences, Akros Pharma, Biotest Pharmaceuticals, Boehringer Ingelheim, Cigna Health Management, CSL Behring, DP Clinical, Grifols, Hansa Medical, Karos Pharmaceuticals, Neurocrine Biosciences, Novartis, Octapharma, Pharnext, Seattle Genetics, Sun Pharmaceuticals, and Syntimmune; is on the data and safety monitoring board for Sanofi, Pledpharma, Pfizer, Johnson & Johnson, Ionis Pharmaceuticals, GlaxoSmithKline, and Axovant Sciences; has licensed technology for the Total Neuropathy Score for Acetylon, AstraZeneca, Calithera Biosciences, Gen-entech, Neurocrine Biosciences, Merrimack Pharmaceuticals, Seattle Genetics, and Shire Development Inc.; and is on the Board of Directors for the Peripheral Nerve Society. B. Jacobs has received funding for research projects from Prinses Beatrix Spierfonds, Horizon 2020, GBS-CIDP Foundation International, Grifols, CSL Behring, and Annexon; is on the Medical Advisory Board for the GBS-CIDP Foundation International; and is a member of the Inflammatory Neuropathy Consortium. Go to Neurology.org/N for full disclosures.
Funding Information:
This study is funded by the GBS-CIDP Foundation International, Gain, Erasmus MC University Medical Centre Rotterdam, Glasgow University, CSL Behring, Grifols, and Annexon.
Publisher Copyright:
© American Academy of Neurology.
PY - 2019/7/2
Y1 - 2019/7/2
N2 - ObjectiveTo define the current treatment practice of Guillain-Barré syndrome (GBS).MethodsThe study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account.ResultsWe excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE.ConclusionsIn current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.
AB - ObjectiveTo define the current treatment practice of Guillain-Barré syndrome (GBS).MethodsThe study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account.ResultsWe excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE.ConclusionsIn current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.
UR - http://www.scopus.com/inward/record.url?scp=85069264584&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069264584&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000007719
DO - 10.1212/WNL.0000000000007719
M3 - Article
C2 - 31175208
AN - SCOPUS:85069264584
VL - 93
SP - E59-E76
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 1
ER -