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. This review was first published in 2011 and this update in 2013.
  
  
  OBJECTIVE
  To review systematically the evidence from randomised controlled trials (RCTs) for pharmacological agents other than plasma exchange, intravenous immunoglobulin and corticosteroids.
  
  
  METHODS
  On 28 August 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register CENTRAL (2012, Issue 8 in The Cochrane Library), MEDLINE (January 1966 to August 2012) and EMBASE (January 1980 to August 2012) for treatments for GBS. We considered evidence from non-randomised studies in the Discussion.
  
  
  METHODS
  We included all randomised or quasi-RCTs 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. This update of the review found no new trials. One RCT 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). Serious adverse events were uncommon with each of these treatments and not significantly commoner in the treated than the control groups.
  
  
  CONCLUSIONS
  The quality of the evidence was very low. Three small RCTs, 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: MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK. rhughes11@btinternet.com.
authors: Richard A C
authors: RA
authors: Hughes
authors: Jane
authors: J
authors: Pritchard
authors: Robert D M
authors: RD
authors: Hadden
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D019208:Brain-Derived Neurotrophic Factor / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid; D005374:Filtration; D020275:Guillain-Barre Syndrome / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000627:therapeutic use*; D028321:Plant Preparations / Q000627:therapeutic use*; D010951:Plasma Exchange; D016032:Randomized Controlled Trials as Topic; D029757:Tripterygium
chemical_list: D000305:Adrenal Cortex Hormones; D019208:Brain-Derived Neurotrophic Factor; D016756:Immunoglobulins, Intravenous; D028321:Plant Preparations; D016899:Interferon-beta; D000068556:Interferon beta-1a