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Evidence summaries

Plasma Exchange for Guillain-Barré Syndrome

Plasma exchange is beneficial in Guillain-Barré syndrome: after one year, full recovery is more likely and severe residual weakness less likely than with supportive care. Level of evidence: "A"

A Cochrane review[Abstract] 1 included 6 studies with a total of 649 patients. All studies compared plasma exchange with supportive treatment alone.

  • Primary outcomes: With severely affected patients, the median time to recover walking with aid was significantly faster with plasma exchange than without (30 vs. 44 days, p< 0.01; one trial, n=220). With mildly affected patients, the median time to onset of motor recovery was significantly shorter with plasma exchange than without (6 vs. 10 days, p< 0.0001; one trial, n=91). After 4 weeks, combined data showed that plasma exchange significantly increased the proportion of patients who recovered the ability to walk with assistance (RR 1.60, 95% CI 1.19 to 2.15; 3 trials, n=349).
  • Secondary outcomes: RR of being improved by one or more grades after 4 weeks was 1.64 (95% CI 1.37 to 1.96; 5 trials, n=623) in favour of plasma exchange. Patients treated with plasma exchange also fared significantly better in time to recover walking without aid (RR 1.72, 95% CI 1.06 to 2.79; 3 trials, n=349) and requirement for artificial ventilation (RR 0.53, 95% CI 0.39 to 0.74; 5 trials, n=623). There were significantly more patients with relapses by the end of follow-up in the plasma exchange than the control group (RR 2.89, 95% CI 1.05 to 7.93; 6 trials, n=649). Despite this, at one year the likelihood of full muscle strength recovery was significantly greater with plasma exchange than without (RR 1.24, 95% CI 1.07 to 1.45; 5 trials, n=404) and the likelihood of severe motor sequelae was significantly less (RR 0.65, 95% CI 0.44 to 0.96; 6 trials, n=649). There was no significant difference in deaths (RR 0.86, 95% CI 0.45 to 1.65; 6 trials, n=649) or patients with adverse events (3 trials, n=556), except fewer arrhythmias in plasma exchange treated patients (RR 0.75, 95% CI 0.56 to 1.00).

    References

    • Raphaël JC, Chevret S, Hughes RA et al. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2012;7():CD001798. [PubMed],

Primary/Secondary Keywords