title: Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain Barré syndrome.
abstract: BACKGROUND
  Plasma exchange and intravenous immunoglobulin, but not corticosteroids, are beneficial in Guillain-Barré syndrome (GBS). The efficacy of other pharmacological agents is unknown.
  
  
  OBJECTIVE
  To review systematically the evidence from randomised controlled trials for pharmacological agents other than plasma exchange, intravenous immunoglobulin and corticosteroids.
  
  
  METHODS
  We searched the Cochrane Neuromuscular Disease Group Specialized Register (5 July 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE (January 1966 to June 2010) and EMBASE (January 1980 to June 2010) for treatments for GBS. We considered evidence from non-randomised studies in the Discussion.
  
  
  METHODS
  We included all randomised or quasi-randomised controlled trials of acute (within four weeks from onset) GBS of all types, ages and degrees of severity. We discarded trials which only tested corticosteroids, intravenous immunoglobulin or plasma exchange. We included other pharmacological treatments or combinations of treatments compared with no treatment, placebo treatment or another treatment.
  
  
  METHODS
  Change in disability after four weeks was the primary outcome. Two authors checked references and extracted data independently. One author entered and another checked data in Review Manager (RevMan). We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. We calculated mean differences and risk ratios with their 95% confidence intervals. We assessed strength of evidence with GradePro software.
  
  
  RESULTS
  Only very low quality evidence was found for four different interventions. One randomised controlled trial with 13 participants showed no significant difference in any outcome between interferon beta-1a and placebo. Another with 10 participants showed no significant difference in any outcome between brain-derived neurotrophic factor and placebo. A third with 37 participants showed no significant difference in any outcome between cerebrospinal fluid filtration and plasma exchange. In a fourth with 20 participants, the risk ratio of improving by one or more disability grades after eight weeks was significantly greater with the Chinese herbal medicine tripterygium polyglycoside than with corticosteroids (risk ratio 1.47; 95% confidence interval 1.02 to 2.11).
  
  
  CONCLUSIONS
  The quality of the evidence was very low. Three small randomised controlled trials, of interferon beta-1a, brain-derived neurotrophic factor and cerebrospinal fluid filtration, showed no significant benefit or harm. A fourth small trial showed that the Chinese herbal medicine tripterygium polyglycoside hastened recovery significantly more than corticosteroids but this result needs confirmation. It was not possible to draw useful conclusions from the few observational studies.
authors.affiliation: MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, PO Box 114, Queen Square, London, UK, WC1N 3BG.
authors.forename: Richard Ac
authors.initials: RA
authors.lastname: Hughes
authors.forename: Jane
authors.initials: J
authors.lastname: Pritchard
authors.forename: Robert Dm
authors.initials: RD
authors.lastname: Hadden
mesh_terms: D019208:Brain-Derived Neurotrophic Factor / Q000627:therapeutic use; D002555:Cerebrospinal Fluid; D005374:Filtration; D020275:Guillain-Barre Syndrome / Q000188:drug therapy*; D006801:Humans; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000627:therapeutic use; D028321:Plant Preparations / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D029757:Tripterygium
chemical_list: D019208:Brain-Derived Neurotrophic Factor; D028321:Plant Preparations; D016899:Interferon-beta; D000068556:Interferon beta-1a