Corticosteroids for Guillain-Barré syndrome

Guillain-Barré syndrome is an uncommon paralysing illness, usually caused by autoimmune inflammation of nerves. In 25% of patients it leads to a requirement for artificial ventilation. About 5% of patients die and about 10% are left with persistent disability. Corticosteroid drugs (such as prednisolone) reduce inflammation and so should theoretically lessen nerve damage. We did not find any new trials in the update of this review but we had previously found eight trials with 653 participants. However, only six trials with 587 participants gave information about the primary outcome measure for this review, change in a seven-point disability scale. When the results of these six trials were pooled there was no significant difference in this or any other outcome. This result was considered unreliable because of marked variations between the trials. In four small trials of oral corticosteroids, with 120 participants, in total there was significantly less improvement after four weeks with corticosteroids than without corticosteroids. In two large trials with a combined total of 467 participants, there was a trend towards more benefit from intravenous corticosteroids in improvement in disability after four weeks but this trend was not significant. Corticosteroids were not associated with a significant increase in harm except that diabetes was significantly more common. Unexpectedly, high blood pressure was much less common in the corticosteroid-treated patients. The lack of more obvious benefit from corticosteroids is not understood but might be because the drugs have a harmful effect on muscles which counteracts the benefit from reducing inflammation in nerves.

Authors' conclusions: 

According to moderate quality evidence, corticosteroids given alone do not significantly hasten recovery from GBS or affect the long-term outcome. According to low quality evidence oral corticosteroids delay recovery. Diabetes requiring insulin was significantly more common and hypertension less common with corticosteroids.

Read the full abstract...

Guillain-Barré syndrome (GBS) is an acute paralysing disease caused by inflammation of the peripheral nerves, which corticosteroids would be expected to benefit.


To examine the ability of corticosteroids to hasten recovery and reduce the long-term morbidity from GBS.

Search strategy: 

We searched The Cochrane Neuromuscular Disease Group Specialized Register (1 November 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), CENTRAL (2011, Issue 4), MEDLINE (January 1966 to October 2011) and EMBASE (January 1980 to October 2011).

Selection criteria: 

We included randomised controlled trials (RCTs) or quasi-RCTs of any form of corticosteroid or adrenocorticotrophic hormone in GBS. Our primary outcome was change in disability grade on a seven-point scale after four weeks. Secondary outcomes included time from randomisation until recovery of unaided walking, time from randomisation until discontinuation of ventilation (for those ventilated), death, death or disability (inability to walk without aid) after 12 months, relapse, and adverse events.

Data collection and analysis: 

Two authors extracted the data independently.

Main results: 

No new trials were discovered in the new searches in June 2009 or November 2011. Six trials with 587 participants provided data for the primary outcome. According to moderate quality evidence, the disability grade change after four weeks in the corticosteroid groups was not significantly different from that in the control groups, mean difference (MD) 0.36 less improvement (95% confidence intervals (CI) 0.16 more to 0.88 less improvement). In four trials of oral corticosteroids with 120 participants in total, there was significantly less improvement after four weeks with corticosteroids than without corticosteroids, MD 0.82 disability grades less improvement (95% CI 0.17 to 1.47). In two trials with a combined total of 467 participants, there was no significant difference, MD 0.17 (95% CI -0.06 to 0.39) of a disability grade more improvement after four weeks with intravenous corticosteroids. According to moderate to high quality evidence, there were no significant differences between the corticosteroid-treated and the control groups in any of the secondary efficacy outcomes. Diabetes was significantly more common and hypertension significantly much less common in the corticosteroid-treated participants.