Clinical efficacy of different doses of gamma globulin combined with glucocorticoid in treatment of moderate/severe acute Guillain-Barré syndrome in children: a comparative analysis
MA Xiao-Yun1, LI Zhao1, WANG Xue-Jun1, YE Jian-Jun1, MA Yong-Ping2, LI Ying3
Department of Pediatric Neurology, Women's and Children's Hospital of Qinghai, Xining 810000, China
Abstract：Objective To investigate the clinical efficacy and safety of intravenous injection of low-dose versus high-dose gamma globulin combined with glucocorticoid pulse therapy in the treatment of children with moderate/severe acute Guillain-Barré syndrome (GBS). Methods A total of 100 children with moderate/severe acute GBS were randomly assigned to low-dose group (n=48) and high-dose group (n=52). The children in the low-dose and high-dose groups were treated with 0.2 g/ (kg·d) and 0.4 g/ (kg·d) gamma globulin respectively combined with methylprednisolone. The two groups were compared in terms of the time to improvements of symptoms after treatment, serum levels of inflammatory factors, proportion of children undergoing invasive ventilation, treatment response rate, and adverse events. Results After 5 days of treatment, the low- and high-dose groups had significant reductions in serum levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein, and there were no significant differences in the reductions of these markers between the two groups. There were no significant differences between the two groups in the time to recovery of respiratory muscle paralysis, time to an improvement in muscle strength of one grade, time to recovery of sensory disturbance, and length of hospital stay. There was no significant difference in the treatment response rate between the low- and high-dose groups (90% vs 92%). There were also no significant differences in the incidence rates of pyrexia, headache, nausea, and palpitation between the two groups. Conclusions Low-dose versus high-dose gamma globulin combined with methylprednisolone pulse therapy have comparable clinical efficacy and safety in the treatment of children with moderate/severe acute GBS.
MA Xiao-Yun,LI Zhao,WANG Xue-Jun et al. Clinical efficacy of different doses of gamma globulin combined with glucocorticoid in treatment of moderate/severe acute Guillain-Barré syndrome in children: a comparative analysis[J]. CJCP, 2016, 18(12): 1286-1290.
van Koningsveld R, Schmitz PI, Meché FG, et al. Effect of methylprednisolone when added to standard treatment with intravenous immunoglobulin for Guillain-Barré syndrome:randomised trial[J]. Lancet, 2004, 363(9404):192-196.
Kerr J, Quinti I, Eibl M, et al. Is dosing of therapeutic immunoglobulins optimal? A review of a three-decade long debate in Europe[J]. Front Immunol, 2014, 5:629.
Vinod KV, Kumar M, Nisar KK. High dose intravenous immunoglobulin may be complicated by myocardial infarction[J]. Indian J Crit Care Med, 2014, 18(4):247-249.
[16]
Elovaara I, Hietaharju A. Can we face the challenge of expanding use of intravenous immunoglobulin in neurology?[J]. Acta Neurol Scand, 2010, 122(5):309-315.
