Re-treatment of Guillain-Barré syndrome (GBS) in the post-SID-GBS trial era

Combining plasma exchange (PE) and intravenous immunoglobulin (IVIG) or sequential treatment courses in Guillain-Barré syndrome (GBS) has not been shown to provide additional benefit over single-course treatment. However, the extent to which re-treatment persists in clinical practice remains unknown. In this study, we aimed to determine the frequency of retreatment, identify factors associated with re-treatment, and compare outcomes between single-treatment and retreated patients.

All patients who underwent inpatient electromyography and nerve conduction studies (EMG/NCS) at the Hospital of the University of Pennsylvania between July 1, 2019 and May 30, 2025 were screened to identify those diagnosed with GBS. Demographics, treatment details, and outcome (defined by GBS disability score [GBS-DS]) were extracted from clinical records and compared between patients receiving single treatment versus retreatment using t-tests for continuous variables and Fisher's exact tests for categorical variables.

Sixty-eight GBS patients were included. Ten patients who did not improve within 1 week after their first treatment were re-treated. There were no significant predisposing factors for re-treatment. Outcome at 6 months was similar between those who were re-treated versus those who were not. Most re-treated patients received more than one round of re-treatment. The most common reasons for re-treatment included clinical worsening or plateau and patient perception of returning symptoms.

A substantial minority of GBS patients continued to receive re-treatment at this single academic medical center despite lack of supporting evidence. The absence of clear clinical variables associated with retreatment suggests that non-evidence-based factors may influence these decisions.