A comparison between IVIg and plasma exchange in Guillain-Barré syndrome : a review and decision analysis of the two treatment modalities

Plasma exchange (PE) has been established as an effective treatment for Guillain-Barré syndrome (GBS), and until recently, was the only treatment significantly to modify the disease course. Data from a recently published Dutch study suggest that intravenous immunoglobulin (IVIg) is as effective as PE in improving the speed of recovery and lessening disability. Recent small case series in the United States have shown unexpectedly high relapse rates in patients with GBS treated with IVIg. At present, clinicians face a dilemma in choosing between the two options, because there is uncertainty about the efficacy and relapse rate associated with IVIg. In this article, we perform a decision analysis that takes into account the efficacy of therapy, relapse rates, and patient preferences with respect to particular outcomes. Although both modalities are quite costly, an economic analysis shows a slight cost advantage for IVIg. Plasma exchange remains to preferred treatment, based on a decision analysis and currently available data. Results of future IVIg trials can be compared to the PE data using the decision-analysis model.