Study Finds Repeat Dosing of IVIG and PLEX Common in GBS, Resulting in Harm to Nonresponders

According to randomized controlled trials, repeat intravenous immune globulin (IVIG) dosing and plasma exchange (PLEX) followed by IVIG (combination therapy) have no additional therapeutic benefit in Guillain-Barré syndrome (GBS) nonresponders. Furthermore, the delineation between GBS and acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) can be particularly challenging and carries therapeutic implications.

In the retrospective study of a large healthcare database for patients with GBS in the U.S. from 2001 to 2018, the researchers identified individuals initially diagnosed with GBS and later reclassified as CIDP. Multivariable logistic regression models were developed to determine associations between patient factors and repeat IVIG dosing, combination therapy and diagnostic reclassification from GBS to CIDP.

They identified 2,325 patients with GBS, of whom a total of 39.7percent received repeat IVIG and 6.1 percent received combination therapy. The proportion of individuals initially diagnosed with GBS and then reclassified as CIDP was 32.0 percent. Repeat IVIG, combination therapy and diagnostic reclassification remained stable over time. Female sex and medium-high net worth were associated with repeat IVIG therapy, while Asian ethnicity was associated with diagnostic reclassification from GBS to CIDP.

The researchers found repeat IVIG dosing was quite common in GBS before newer trials suggesting harm in nonresponders, and IVIG/PLEX combination therapy continues to persist despite strong evidence against use in nonresponders. Further, nearly one in three patients initially diagnosed with GBS is subsequently diagnosed with CIDP, but the reasons are unclear.