Plasma exchange for Guillain-Barré syndrome
Editorial Group: Cochrane Neuromuscular Disease Group
Published Online: 11 JUL 2012
Assessed as up-to-date: 14 JUN 2011
Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Raphaël JC, Chevret S, Hughes RAC, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD001798. DOI: 10.1002/14651858.CD001798.pub2.
- Publication Status: New search for studies and content updated (no change to conclusions)
- Published Online: 11 JUL 2012
Guillain-Barré syndrome is an acute paralysing disease caused by peripheral nerve inflammation. This is an update of a review first published in 2001 and last updated in 2008.
To assess the effects of plasma exchange for treating Guillain-Barré syndrome.
We searched the Cochrane Neuromuscular Disease Group Specialized Register (14 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 2), MEDLINE (January 1966 to June 2011) and EMBASE (January 1980 to June 2011).
Randomised and quasi-randomised trials of plasma exchange versus sham exchange or supportive treatment.
Data collection and analysis
Two review authors agreed the selection of eligible studies and independently assessed the risk of bias in included studies. Data were extracted by one review author and checked by a second review author. Likewise data for adverse events were extracted by one review author and checked by a second review author.
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. Overall the included trials had a low risk of bias.
In one trial with 220 severely affected participants, the median time to recover walking with aid was significantly faster; with plasma exchange (30 days) than without (44 days). In another trial with 91 mildly affected participants, the median time to onset of motor recovery was significantly shorter with plasma exchange (six days) than without (10 days). After four weeks, combined data from three trials accounting for a total of 349 patients showed that plasma exchanged significantly increased the proportion of patients who recovered the ability to walk with assistance (risk ratio (RR) 1.60, 95% confidence interval (CI) 1.19 to 2.15).
In five trials with 623 participants in total, the RR 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. Participants treated with plasma exchange also fared significantly better in time to recover walking without aid (three trials with 349 participants, RR 1.72 (95% CI 1.06 to 2.79)) and requirement for artificial ventilation (five trials with 623 participants, RR 0.53 (95% CI 0.39 to 0.74)). There were significantly more participants with relapses by the end of follow-up in the plasma exchange than the control group (6 trials with 649 participants, RR 2.89 (95% CI 1.05 to 7.93)). Despite this, at one year the likelihood of full muscle strength recovery was significantly greater with plasma exchange than without (five trials with 404 participants, RR 1.24 (95% CI 1.07 to 1.45)) and the likelihood of severe motor sequelae was significantly less (six trials with 649 patients, RR 0.65 (95% CI 0.44 to 0.96)). There was no significant difference in deaths (six trials with 649 participants, RR 0.86 (95% CI 0.45 to 1.65)) or participants with adverse events (three trials with 556 participants), except fewer arrhythmias in plasma exchange treated participants (RR 0.75 (95% CI 0.56 to 1.00)).
Moderate-quality evidence shows significantly more improvement with plasma exchange than supportive care alone in adults with Guillain-Barré syndrome without a significant increase in serious adverse events. There was a small but significant increase in the risk of relapse during the first six to 12 months after onset in people treated with plasma exchange compared with those that were not treated. Despite this, after one year, full recovery was significantly more likely and severe residual weakness less likely with plasma exchange.
Plain language summary
Plasma exchange for Guillain-Barré syndrome
Guillain-Barré syndrome is a rare but serious inflammatory disease of the peripheral nerves (nerves outside the central nervous system) that causes paralysis. Many people who develop Guillain-Barré syndrome have often had a recent chest or intestine infection that may cause an allergic response in the nerves. Autoimmune factors such as antibodies are thought to cause the disease, so plasma exchange is used to treat Guillain-Barré syndrome. Plasma exchange aims to remove these antibodies from the blood stream and replace them with artificial plasma, usually albumin. This review of six randomised controlled trials with a low risk of bias involving 649 participants found that plasma exchange helps speed recovery from Guillain-Barré syndrome without causing harm apart from being followed by a slightly increased risk of relapse. No new trials have been done since the first publication of this review in 2001.