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. 2024 Dec;70(6):1192-1199.
doi: 10.1002/mus.28265. Epub 2024 Sep 26.

Intravenous immunoglobulin and plasma exchange prescribing patterns for Guillain-Barre Syndrome in the United States-2001 to 2018

Amro M Stino  1 , Evan L Reynolds  1 , Maya Watanabe  2 , Brian C Callaghan  1
Affiliations

Intravenous immunoglobulin and plasma exchange prescribing patterns for Guillain-Barre Syndrome in the United States-2001 to 2018

Amro M Stino et al. Muscle Nerve. 2024 Dec.

Abstract

Introduction/aims: Randomized controlled trials show that repeat intravenous immunoglobulin (IVIG) dosing and plasma exchange (PLEX) followed by IVIG (combination therapy) have no additional therapeutic benefit in Guillain-Barre Syndrome (GBS) non-responders. Furthermore, the delineation between GBS and Acute Onset CIDP (A-CIDP) can be particularly challenging and carries therapeutic implications. We aimed to evaluate the presence of repeat IVIG, combination therapy, and diagnostic reclassification from GBS to CIDP.

Methods: We performed a retrospective study of a large healthcare database for patients with GBS in the US from 2001 to 2018. We identified individuals initially diagnosed with GBS and later re-classified as CIDP. Multivariable logistic regression models were developed to determine associations between patient factors and repeat IVIG dosing, combination therapy, and diagnostic re-classification from GBS to CIDP.

Results: We identified 2325 patients with GBS. A total of 39.7% received repeat IVIG and 6.1% received combination therapy. The proportion of individuals initially diagnosed with GBS and then re-classified as CIDP was 32.0%. Repeat IVIG, combination therapy, and diagnostic reclassification remained stable over time. Female sex (OR 0.79, 95% CI 0.65-0.96) and medium-high net worth (OR 0.64, 95% CI 0.45-0.90) associated with repeat IVIG therapy, while Asian ethnicity associated with diagnostic re-classification from GBS to CIDP (OR 1.77, 95% CI 1.09-2.86).

Discussion: Repeat IVIG dosing was quite common in GBS before newer trials suggesting harm in non-responders, and IVIG/PLEX combination therapy continues to persist despite strong evidence against use in non-responders. Further, nearly one in three patients initially diagnosed with GBS is subsequently diagnosed with CIDP, but the reasons are unclear.

Keywords: Guillain‐Barré Syndrome; United States; healthcare utilization; intravenous immunoglobulin; plasma exchange.

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Conflict of interest statement

AS consults for Argenx, Annexon, CSL Behring, InCircle Review, Sanofi, and Takeda. He has received research support from the GBS-CIDP Foundation, the Foundation for Peripheral Neuropathy, and Bristol Myers Squibb. ER is supported by the NIH NIDDK (K99DK129785). MW reports no relevant conflicts of interest. BCC consults for DynaMed, performs medical legal consultations including consultations for the Vaccine Injury Compensation Program, receives research support from the American Academy of Neurology, and is an associate editor for Neurology.

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