Hughes RAC, Brassington R, Gunn A, van Doorn PA. Corticosteroids for Guillain-Barré syndrome. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD001446. DOI: 10.1002/14651858.CD001446.pub5
Do corticosteroids hasten recovery from disability in people with Guillain-Barré syndrome compared with dummy (placebo) treatment or supportive care alone?
Guillain-Barré syndrome is an uncommon paralysing illness, usually caused when the person’s immune system attacks their own nerves, which consequently become inflamed. In 25% of people affected, the disease leads to a need for artificial ventilation. About 5% of people with the disease die and about 10% are left disabled. Corticosteroids (such as prednisolone) reduce inflammation and so should reduce nerve damage.
There were eight clinical trials with altogether 653 participants. Only six trials with altogether 587 participants gave information about the primary outcome measure for this review, which was change in a seven-point disability scale. Financial support came from Baxter Bioscience for one trial, research councils for two trials, the National Institutes of Health for one trial, and unstated sources for the others.
Key results and quality of the evidence
According to moderate quality evidence, when we pooled the results of the six trials with the necessary information there was no significant difference in change in disability grade after four weeks. Also according to moderate quality evidence, there was no difference in the percentage of participants who died or were left disabled after one year. We considered the evidence about disability unreliable because of marked variations between the trials. In four small trials of oral corticosteroids, with 120 participants, there was significantly less improvement after four weeks with corticosteroids than without corticosteroids but we considered the evidence quality very low. By contrast, according to moderate quality evidence, in two large trials of intravenous (injected into a vein) corticosteroids with a combined total of 467 participants, there was a slight improvement in disability after four weeks, but the results allowed for the possibility of no effect. Corticosteroids were not associated with a significant increase in harm except that diabetes was significantly more common than with placebo or supportive treatment alone. Although high blood pressure is a known harmful effect of corticosteroids, high blood pressure was unexpectedly much less common in the corticosteroid-treated participants. The lack of benefit from corticosteroids is not understood but might be because the drugs have a harmful effect on muscles which counteracts the benefit from reducing inflammation in nerves.
According to moderate quality evidence, corticosteroids given alone do not significantly hasten recovery from GBS or affect the long-term outcome. According to very low quality evidence, oral corticosteroids delay recovery. Diabetes requiring insulin was more common and hypertension less common with corticosteroids based on high quality evidence.