Cochrane · systematic review · CD008630
Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain‐Barré syndrome
Doets, AY, Hughes, RAC, Brassington, R, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
35
current version
GRADE rated
25
No studies
8
Included studies
NR
No studies 8 · 22.9%Ungraded 2 · 5.7%Very low 19 · 54.3%Low 6 · 17.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyInterferon beta‐1a versus placebo for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Scale ranges from grade 0 to 6 where 0 is healthy and 6 is dead Interferon beta‐1a vs placebo | no estimate extracted | 1 study · 19 participants | Very low Downgraded: imprecision |
Improvement in disability grade Defined as achievement of a specified degree of improvement Interferon beta‐1a vs placebo | RR 1.08 [0.42, 2.77] | 1 study · 19 participants | Very low Downgraded: imprecision |
Time from randomisation until recovery of unaided walking (median, days (95% CI)) Interferon beta‐1a vs placebo | no estimate extracted | 1 study · 19 participants | Very low Downgraded: imprecision |
Time from randomisation until discontinuation of ventilation (for those ventilated) Interferon beta‐1a vs placebo | no estimate extracted | NR | No studies |
Death Interferon beta‐1a vs placebo | RR 1.5 [0.07, 32.29] | 1 study · 19 participants | Low Downgraded: imprecision |
Death or disability after 12 months Interferon beta‐1a vs placebo | no estimate extracted | NR | No studies |
Participants with 1 or more serious adverse events Interferon beta‐1a vs placebo | RR 0.92 [0.23, 3.72] | 1 study · 19 participants | Very low Downgraded: imprecision |
Brain‐derived neurotrophic factor versus placebo for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Scale ranges from grade 0 to 6 where 0 is healthy and 6 is dead Brain‐derived neurotrophic factor vs placebo | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Improvement in disability grade Defined as achievement of a specified degree of improvement Brain‐derived neurotrophic factor vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Time from randomisation until recovery of unaided walking, (median, days (95% CI)) Brain‐derived neurotrophic factor vs placebo | no estimate extracted | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Time from randomisation until discontinuation of ventilation (for those ventilated) (median, weeks (range)) Brain‐derived neurotrophic factor vs placebo | no estimate extracted | 1 study · 5 participants | Very low Downgraded: risk of bias, imprecision |
Death Brain‐derived neurotrophic factor vs placebo | RR 0.67 [0.06, 7.85] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Death or disability after 12 months Brain‐derived neurotrophic factor vs placebo | RR 1.33 [0.17, 10.25] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Participants with 1 or more serious adverse events Brain‐derived neurotrophic factor vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low Downgraded: risk of bias, imprecision |
Cerebrospinal fluid filtration versus plasma exchange for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Scale ranges from grade 0 to 6 where 0 is healthy and 6 is dead Cerebrospinal fluid filtration vs plasma exchange | no estimate extracted | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Improvement in disability grade Defined as achievement of a specified degree of improvement Cerebrospinal fluid filtration vs plasma exchange | RR 0.94 [0.48, 1.84] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Time from randomisation until recovery of unaided walking (median, days (range)) Cerebrospinal fluid filtration vs plasma exchange | no estimate extracted | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Time from randomisation until discontinuation of ventilation (for those ventilated) Cerebrospinal fluid filtration vs plasma exchange | no estimate extracted | NR | No studies |
Death Cerebrospinal fluid filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Low Downgraded: imprecision |
Death or disability after 12 months Cerebrospinal fluid filtration vs plasma exchange | no estimate extracted | NR | No studies |
Participants with 1 or more serious adverse events Cerebrospinal fluid filtration vs plasma exchange | RR 0.13 [0.01, 2.25] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Tripterygium polyglycoside versus corticosteroids for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Scale ranges from grade 0 to 6 where 0 is healthy and 6 is dead Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Improvement in disability grade Defined as achievement of a specified degree of improvement Tripterygium polyglycoside vs corticosteroids | RR 1.47 [1.02, 2.11] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Time from randomisation until recovery of unaided walking Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Time from randomisation until discontinuation of ventilation (for those ventilated) Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Death Tripterygium polyglycoside vs corticosteroids | no estimate extracted | 1 study · 43 participants | Ungraded |
Death or disability after 12 months Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Participants with 1 or more serious adverse events Tripterygium polyglycoside vs corticosteroids | no estimate extracted | 1 study · 43 participants | Ungraded |
Eculizumab versus placebo for Guillain‐Barré syndrome
Population: adults with severe Guillain‐Barré syndrome (GBS disability score > 2), within 2 weeks form onset
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Scale ranges from grade 0 to 6 where 0 is healthy and 6 is dead Eculizumab vs placebo | no estimate extracted | 2 studies · 40 participants | Very low Downgraded: imprecision, inconsistency |
Improvement in disability grade Defined as achievement of a specified degree of improvement Eculizumab vs placebo | RR 0.85 [0.43, 1.69] | 2 studies · 40 participants | Low Downgraded: imprecision |
Time from randomisation until recovery of unaided walking (mean, weeks) Eculizumab vs placebo | no estimate extracted | 1 study · 7 participants | Low Downgraded: imprecision |
Time from randomisation until discontinuation of ventilation (for those ventilated) Eculizumab vs placebo | no estimate extracted | 2 studies · 8 participants | Very low Downgraded: imprecision, inconsistency |
Death Eculizumab vs placebo | RR 1.5 [0.08, 26.86] | 2 studies · 38 participants | Low Downgraded: imprecision |
Death or disability after 12 months In the absence of data at 12 months, we report the outcome at 6 months Eculizumab vs placebo | RR 1.21 [0.15, 10.11] | 2 studies · 38 participants | Very low Downgraded: imprecision, indirectness |
Participants with 1 or more serious adverse events Eculizumab vs placebo | RR 1.9 [0.34, 10.5] | 2 studies · 41 participants | Low Downgraded: imprecision |
IFNb‐1a versus placebo for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks IFNb‐1a vs placebo | no estimate extracted | 1 study · 19 participants | Very low Downgraded: imprecision |
Improvement by one or more disability grade after 4 weeks IFNb‐1a vs placebo | RR 1.08 [0.42, 2.77] | 1 study · 19 participants | Very low Downgraded: imprecision |
Death or disability after 12 months (not measured) IFNb‐1a vs placebo | no estimate extracted | NR | No studies |
Death IFNb‐1a vs placebo | RR 1.5 [0.07, 32.29] | 1 study · 19 participants | Very low Downgraded: imprecision |
Participants with 1 or more serious adverse events IFNb‐1a vs placebo | RR 0.92 [0.23, 3.72] | 1 study · 19 participants | Very low Downgraded: imprecision |
BDNF versus placebo for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks BDNF vs placebo | no estimate extracted | 1 study · 10 participants | Very low Downgraded: imprecision |
Improvement by one or more disability grade after 4 weeks BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low Downgraded: imprecision |
Death or disability after 12 months BDNF vs placebo | RR 1.33 [0.17, 10.25] | 1 study · 10 participants | Very low Downgraded: imprecision |
Death BDNF vs placebo | RR 0.67 [0.06, 7.85] | 1 study · 10 participants | Very low Downgraded: imprecision |
Participants with 1 or more serious adverse events BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low Downgraded: imprecision |
CSF filtration versus plasma exchange for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks CSF filtration vs plasma exchange | no estimate extracted | 1 study · 31 participants | Very low Downgraded: risk of bias, imprecision |
Improvement by one or more disability grade after 4 weeks CSF filtration vs plasma exchange | RR 0.94 [0.48, 1.84] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Death or disability after 12 months CSF filtration vs plasma exchange | no estimate extracted | NR | No studies |
Death CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Low Downgraded: imprecision |
Participants with 1 or more serious adverse events CSF filtration vs plasma exchange | RR 0.13 [0.01, 2.25] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events leading to cessation of treatment CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Tripterygium polyglycoside versus corticosteroids for Guillain‐Barré syndrome
Population: people with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks (not reported) Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Improvement by one or more disability grade after 4 weeks Tripterygium polyglycoside vs corticosteroids | RR 1.47 [1.02, 2.11] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Death or disability after 12 months Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Death Tripterygium polyglycoside vs corticosteroids | no estimate extracted | 1 study · 43 participants | Ungraded |
Participants with 1 or more serious adverse events Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Adverse events Tripterygium polyglycoside vs corticosteroids | RR 2.87 [0.12, 66.75] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
IFNb‐1a versus placebo for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks IFNb‐1a vs placebo | no estimate extracted | 1 study · 19 participants | Very low |
Improvement in disability grade by one or more points after 4 weeks IFNb‐1a vs placebo | RR 1.08 [0.42, 2.77] | 1 study · 19 participants | Very low |
Death IFNb‐1a vs placebo | RR 1.5 [0.07, 32.29] | 1 study · 19 participants | Very low |
Participants with 1 or more serious adverse events IFNb‐1a vs placebo | RR 0.92 [0.23, 3.72] | 1 study · 19 participants | Very low |
BDNF versus placebo for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks BDNF vs placebo | no estimate extracted | 1 study · 10 participants | Very low |
Improvement in disability grade by one or more points after 4 weeks BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low |
Death BDNF vs placebo | RR 0.67 [0.06, 7.85] | 1 study · 10 participants | Very low |
Death or disability after 12 months BDNF vs placebo | RR 1.33 [0.17, 10.25] | 1 study · 10 participants | Very low |
Serious adverse events BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low |
CSF filtration versus plasma exchange for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks CSF filtration vs plasma exchange | no estimate extracted | 1 study · 31 participants | Very low Downgraded: risk of bias |
Improvement in disability grade by one or more points after 4 weeks CSF filtration vs plasma exchange | RR 0.94 [0.48, 1.84] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Death CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Low |
Serious adverse events CSF filtration vs plasma exchange | RR 0.13 [0.01, 2.25] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Adverse events leading to cessation of treatment CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Tripterygium polyglycoside versus corticosteroids for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks Tripterygium polyglycoside vs corticosteroids | no estimate extracted | NR | No studies |
Improvement in disability grade by one or more points after 8 weeks Tripterygium polyglycoside vs corticosteroids | RR 1.47 [1.02, 2.11] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Death Tripterygium polyglycoside vs corticosteroids | no estimate extracted | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Tripterygium polyglycoside vs corticosteroids | RR 2.87 [0.12, 66.75] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
IFN‐b1a versus placebo for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks IFN‐b1a vs placebo | no estimate extracted | 1 study · 19 participants | Very low |
Improvement by 1 or more grades after 4 weeks IFN‐b1a vs placebo | RR 1.08 [0.42, 2.77] | 1 study · 19 participants | Very low |
Death IFN‐b1a vs placebo | RR 1.5 [0.07, 32.29] | 1 study · 19 participants | Very low |
Participants with 1 or more serious adverse events IFN‐b1a vs placebo | RR 0.92 [0.23, 3.72] | 1 study · 19 participants | Very low |
New Outcome IFN‐b1a vs placebo | RR 0 [0, 0] | 0 studies · 0 participants | Ungraded |
BDNF versus placebo for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks BDNF vs placebo | no estimate extracted | 1 study · 10 participants | Very low |
Improvement in disability grade by one or more points after 4 weeks BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low |
Death BDNF vs placebo | RR 0.67 [0.06, 7.85] | 1 study · 10 participants | Very low |
Death or disability after 12 months BDNF vs placebo | RR 1.33 [0.17, 10.25] | 1 study · 10 participants | Very low |
Serious adverse events BDNF vs placebo | RR 1 [0.28, 3.54] | 1 study · 10 participants | Very low |
CSF filtration versus plasma exchange for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade after 4 weeks CSF filtration vs plasma exchange | no estimate extracted | 1 study · 31 participants | Very low Downgraded: risk of bias |
Improvement by 1 or more grades after 4 weeks CSF filtration vs plasma exchange | RR 0.94 [0.48, 1.84] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Death CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Low |
Serious adverse events CSF filtration vs plasma exchange | RR 0.13 [0.01, 2.25] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Adverse events leading to cessation of treatment CSF filtration vs plasma exchange | RR 1.18 [0.08, 17.42] | 1 study · 37 participants | Very low Downgraded: risk of bias |
Tripterygium polyglycoside versus corticosteroids for Guillain‐Barré syndrome
Population: patients with Guillain‐Barré syndrome
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Improvement in disability grade by one or more points after 8 weeks Tripterygium polyglycoside vs corticosteroids | RR 1.47 [1.02, 2.11] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Tripterygium polyglycoside vs corticosteroids | RR 2.87 [0.12, 66.75] | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |