Corticosteroids for Guillain-Barré syndrome

 

Abstract

Background

Guillain-Barré syndrome is caused by inflammation of the peripheral nerves, which corticosteroids should benefit.

Objectives

To examine the efficacy of corticosteroids.

Search methods

We searched The Cochrane Neuromuscular Disease Group Trials Specialized Register (June 2009), MEDLINE (January 1966 to June 2009) and EMBASE from (January 1980 to June 2009).

Selection criteria

We included quasi-randomised or randomised controlled trials of any form of corticosteroid or adrenocorticotrophic hormone. 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.

Main results

No new trials were discovered in the new search in June 2009. 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, weighted mean difference (WMD) 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, WMD 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, WMD 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.

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 and hypertension less common with corticosteroids.

 

Plain language summary

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 could 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 in the two trials of intravenous corticosteroids 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.

 

摘要

背景

以類固醇治療感染性多發性神經根炎

感染性多發性神經根炎是由周邊神經發炎引起，因此類固醇對此應該有一定的好處。

目標

檢視類固醇的療效。

搜尋策略

我們搜尋了The Cochrane Neuromuscular Disease Group Trials Specialized Register﹝2009年6月﹞、MEDLINE﹝1966年1月到2009年6月﹞以及 EMBASE﹝1980年1月到2009年6月﹞。

選擇標準

我們收錄使用類固醇或促腎上腺皮質素的半隨機或隨機對照試驗。我們的主要結果是使用藥物4週後，以一個7分的量表評估障礙等級的改變。次要結果包括隨機分組到可獨立行走經過的時間、隨機分組到停止使用人工換氣經過的時間﹝對於那些有使用人工換氣的人﹞、死亡、12個月後死亡或殘障﹝無法在沒有輔助的情況下行走﹞、復發及不良反應。

資料收集與分析

由兩位作者負責擷取數據。

主要結論

2009年6月新開始的蒐尋中，沒有找到任何新的試驗。6組試驗總共587位參與者提供主要結果的數據。根據品質中等的證據，比較使用類固醇的組別和對照組，4週後殘障等級的改變沒有顯著的差異，加權平均差﹝WMD﹞0.36以下改善﹝95% confidence intervals (CI) 0.16以上到0.88以下改善﹞。在4個包含120人，使用口服類固醇的試驗，使用類固醇的組別4週後的改善情況明顯的比沒有使用類固醇的差，WMD 0.82殘障等級改善較少，95% CI 0.17到1.47﹞。在2個總共包含467位參與者的試驗中，組間沒有顯著差異，WMD 0.17﹝95% CI −0.06到0.39﹞，使用靜脈注射類固醇的組別在4周後，餐障等級有顯著改善。根據品質中到高等的證據，在次要結果方面，使用類固醇治療的組別和對照組間沒有顯著差異。在使用類固醇治療的參與者中，糖尿病很明顯的比較常見，而高血壓則比較少見。

作者結論

根據品質中等的證據，單獨使用類固醇不會加速GBS的復原速度或是影響長期結果。根據品質低的證據，口服類固醇會使復原變慢。使用類固醇的人，較常發生需要補充胰島素的糖尿病而高血壓則比較少見。

翻譯人

本摘要由朱奕蓁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以類固醇治療感染性多發性神經根炎 感染性多發性神經根炎是一個常見能使人癱瘓的疾病，通常是由自體免疫造成的神經發炎引起的。25%的病人可能會因此需要人工換氣。約有5%的病人會死亡，10%的會成為殘障。類固醇藥物﹝像是prednisolone﹞能減少發炎狀況，因此理論上能減少神經損傷。在這次評論更新時，我沒有找到新的試驗，但我們先前已經找到8個共包和653位參與者的試驗。然而，只有6個試驗，總共587位參與者，能提供評估主要結果的資訊，即7分殘障量表的改變。統整這些結果後，發現在這個結果或是其它結果都沒有發現顯著差異。我們認為這樣的結果並不可靠，因為這些試驗設計有顯著的差異。在4個使用口服類固醇，包含120位參與者的小試驗中，總體而言，4周後使用類固醇的組別的改善程度很顯著的比沒使用類固醇的組別小。在2個總共包含467位參與者的大型試驗中，根據4周後殘障情況的改善，傾向認為靜脈注射類固醇較好。除了在這2個使用靜脈類固醇的試驗中，糖尿病比常見外，類固醇和傷害沒有顯著的關連。出乎意料的是，高血壓在使用類固醇的病人中比較少見。我們不了解類固醇為何沒有較顯著的好處，有可能是因為這種藥物對肌肉造成傷害，抵消了減少神經發炎的好處。