Second IVIg Course in Guillain-Barré Syndrome Patients with Poor Prognosis

Background: Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy typically managed with a single course of intravenous immunoglobulin (IVIg) at a dose of 2 g/kg. However, some patients show limited recovery despite adequate initial treatment, leading to consideration of a second IVIg course. Objective: To assess the possible therapeutic value of administering a second IVIg cycle in GBS patients who exhibit bad or no response to initial therapy and to determine its effect on disease progression. Subjects and methods: Patients predicted to have a poor prognosis based on the modified Erasmus GBS Outcome Score at week one were divided into two arms: single versus double IVIg courses. The GBS disability score, as the primary outcome, was analyzed at 4 and 26 weeks using multivariable ordinal regression. Results: Individuals with and without clinical improvement did not differ significantly regarding demographic or clinical variables. A significant association was found between improvement and normal electrophysiological findings. Receiving a second IVIg course and having normal electrophysiological classification independently increased the risk of no improvement by 15.16-fold and 8.99-fold, respectively. Conclusion: A second course of IVIg does not enhance recovery in GBS individuals with bad or no response to initial management and offers no additional therapeutic advantage.