Guillain-Barré syndrome is one of the best understood inflammatory neurological diseases. Despite this understanding, there has been arguably little progress in therapeutics. The Article by Christa Walgaard and colleagues1 published in The Lancet Neurology, describes the absence of effect of a second dose of intravenous immunoglobulin in the treatment of Guillain-Barré syndrome, highlights real potential harms with second doses, and should reignite a search for safer and more efficacious new treatments. 93 patients were included in the modified intention-to-treat analysis: 49 (53%) received a second intravenous immunoglobulin dose and 44 (47%) received placebo. The adjusted common odds ratio for improvement on the Guillain-Barre syndrome disability score at 4 weeks was 1.4 (95% CI 0.6-3.3; p=0.45). However, 51% of the patients who received a second dose versus 23% of patients in the placebo group had severe adverse events, with the thromboembolic and vascular events occurring within 4 weeks after infusion.
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