LandmarkRCT

GBS IVIG vs PLEX

Randomised Trial of Plasma Exchange, Intravenous Immunoglobulin, and Combined Treatments in Guillain-Barré Syndrome

Lancet, 1997 · Multicenter, randomized controlled trial

Clinical question

Is IVIG equivalent to plasma exchange, and does combining both provide additional benefit in severe Guillain-Barré syndrome?

Population: 383 adult patients with severe Guillain-Barré syndrome unable to walk unaided within 14 days of onset
Intervention: IVIG (0.4 g/kg/day for 5 days) alone or Plasma Exchange (5 exchanges) followed by IVIG
Comparator: Plasma Exchange alone (5 exchanges over 8–13 days)
Primary outcome: Change in disability scale grade at 4 weeks
Result: Mean disability grade improvement at 4 weeks was identical between IVIG (0.97) and Plasma Exchange (0.87, P = 0.67). Combining plasma exchange and IVIG conferred no significant additional benefit (1.10, P = 0.19). (Mean difference 0.10 (95% CI -0.10 to 0.33), 0.67)

What the trial found

IVIG has equivalent efficacy to plasma exchange in severe Guillain-Barré syndrome, and combining both modalities provides no added benefit.

Current guideline position

Class 1 recommendation in AAN/EAN guidelines for either IVIG or plasma exchange in severe GBS.

Clinical interpretation

Establishes IVIG (2 g/kg total) and plasma exchange as equally efficacious first-line disease-modifying therapies, with IVIG preferred in many centers due to convenience and ease of administration in ICU.

High certainty

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