Therapeutic issues in Guillain-Barré syndrome

Guillain-Barré syndrome or acute inflammatory polyradiculoneuropathy is an inflammatory disease of peripheral nerves, which usually leads to tetraparesis of acute onset. It can lead to major residual disability in some patients despite current treatment options that have shown a favorable impact on the natural course of the disease.

This review focuses on the disease-modifying treatments that have been approved or are currently investigated for the treatment of Guillain-Barré syndrome. The authors also give their expert perspectives.

Current treatment options, albeit efficacious, are not always able to stop the disease course of Guillain-Barré syndrome. It is admitted that patients with a benign course should be carefully monitored but don't necessarily require specific treatment. In all other cases, specialized care and use of plasma exchange or intravenous immunoglobulin is required as soon as possible. The sequential use of both treatments has not shown any particular benefit, and it has recently been demonstrated that two courses of intravenous immunoglobulin do not perform better than one. There is therefore an urgent need to develop new therapeutic strategies for this sometimes-devastating disease, with promising options targeting the complement or autoantibodies. It remains important to discover biomarkers of disease activity, to select patients for intensive treatment and to identify if different treatment options should be used in different variants of Guillain-Barré syndrome.