Acute Management of Guillain-Barré Syndrome: A Narrative Review

Guillain-Barré syndrome (GBS) is a rapidly progressive immune-mediated polyradiculoneuropathy that can cause respiratory failure, autonomic dysfunction, and significant long-term disability. This narrative review examines the acute management of GBS, including supportive care, established immunotherapies, and emerging treatment strategies. Early recognition and close monitoring of respiratory and autonomic function remain essential, particularly during the progressive phase of disease. Intravenous immunoglobulin (IVIg) and plasma exchange remain the primary disease-modifying treatments and have similar overall efficacy, although both primarily accelerate recovery rather than prevent ongoing nerve injury. Their limitations, including treatment-related fluctuations, adverse effects, cost, supply limitations, and the logistical challenges of plasma exchange, highlight the need for more effective therapies. Emerging treatments are increasingly targeting specific mechanisms involved in GBS pathophysiology. Although the C5 inhibitor eculizumab failed to improve outcomes in a phase 3 trial, early results with the upstream C1q inhibitor ANX005 suggest that earlier complement inhibition may reduce nerve injury and improve functional outcomes. Other investigational approaches include IgG-degrading enzymes such as imlifidase, FcRn inhibitors such as efgartigimod, regulatory T-cell therapies, and regenerative strategies. However, most of these treatments lack adequately powered randomized clinical trial data. Important gaps also remain in subtype-specific treatment, nerve regeneration, long-term rehabilitation, treatment-related fluctuations, and access to care. Future research should focus on more targeted and individualized therapies that address both immune-mediated injury and subsequent nerve damage.