Plasma exchange for Guillain-Barré syndrome

Background

Guillain-Barré syndrome is an acute paralysing disease due to peripheral nerve inflammation.

Objectives

To systematically review the evidence on plasma exchange for treating Guillain-Barré syndrome.

Search strategy

We searched the Cochrane Neuromuscular Disease Group Trials Register (January 2008), MEDLINE (January 1966 to January 21 2008) and EMBASE (January 1980 to January 21 2008) .

Selection criteria

Randomised and quasi-randomised trials of plasma exchange versus sham exchange or supportive treatment.

Data collection and analysis

Two authors agreed the selection of eligible studies with a third author. Data were extracted by one author and checked by a second.

Main results

In the first version of this review there were six eligible trials concerning 649 participants comparing plasma exchange with supportive treatment. No new eligible trials have been identified in subsequent updates.

Primary outcome measures
In one trial with 220 severely affected participants, the median time to recover walking with aid was significantly faster, 30 days, with plasma exchange than without, 44 days. In another trial with 91 mildly affected participants, this time was not significantly different but the median time to onset of motor recovery was significantly shorter, 6 days, with plasma exchange than without, 10 days.

Secondary outcome measures
In five trials with 623 patients in total, the relative risk of being improved by one or more grades after four weeks was 1.64 ( 95% CI 1.37 to 1.96) in favour of plasma exchange. Patients treated with plasma exchange also fared significantly better in time to recover walking without aid, requirement for artificial ventilation, duration of ventilation, and full muscle strength recovery and severe sequelae after one year. There were fewer patients with infectious events and cardiac arrhythmias in the plasma exchange than the control group.

Authors' conclusions

In mild Guillain-Barré syndrome, two sessions of plasma exchange are significantly superior to none. In moderate Guillain-Barré syndrome four sessions are significantly superior to two. In severe Guillain-Barré syndrome, six sessions of plasma exchange are not significantly better than four. Continuous flow plasma exchange machines may be superior to intermittent flow machines and albumin to fresh frozen plasma as the exchange fluid. Plasma exchange is more beneficial when started within seven days after disease onset rather than later, but was still beneficial in patients treated up to 30 days after disease onset. The value of plasma exchange in children less than 12 years old is not known. There is insufficient evidence to determine whether cerebrospinal fluid filtration is equivalent to plasma exchange.