Rajabally, Yusuf A. (2022). Immunoglobulin and Monoclonal Antibody Therapies in Guillain-Barré Syndrome. Neurotherapeutics, 19 (3), pp. 885-896.
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy affecting 1–2 subjects per 100,000 every year worldwide. It causes, in its classic form, symmetric weakness in the proximal and distal limb muscles with common involvement of the cranial nerves, particularly facial weakness. Respiratory function is compromised in a case in four. Randomised controlled trials have demonstrated the benefit of therapeutic plasma exchange in hastening time to recovery. Intravenous immunoglobulin was subsequently shown to be as efficacious as plasma exchange in adult subjects. In children, few trials have shown the benefit of intravenous immunoglobulin versus supportive care. Pharmacokinetic studies suggested a relationship between increase in immunoglobulin G level post-infusion and outcome, implying administration of larger doses may be beneficial in subjects with poor prognosis. However, a subsequent trial of a second dose of immunoglobulin in such subjects failed to show improved outcome, while demonstrating a higher risk of thromboembolic side-effects. Monoclonal antibody therapy has more recently been investigated for GBS, after multiple studies in animal models, with different agents and variable postulated mechanisms of action. Eculizumab, a humanised monoclonal antibody against the complement protein C5, was tested in in two randomised, double-blind, placebo-controlled phase 2 trials. Neither showed benefit versus immunoglobulins alone on disability level at 4 weeks, although one study importantly suggested possible, clinically highly relevant, late effects on normalising function. A phase 3 trial is in progress. Preliminary results of a placebo-controlled ongoing study of ANX005, a humanised recombinant antibody against C1q inhibiting the complement cascade, have been promising.
Publication DOI: | https://doi.org/10.1007/s13311-022-01253-4 |
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Divisions: | College of Health & Life Sciences |
Funding Information: | YAR has received speaker/consultancy honoraria from LFB, Polyneuron and Argenx, has received educational sponsorships from LFB and CSL Behring and has obtained research grants from LFB and CSL Behring. |
Additional Information: | This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changeswere made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view acopy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
Uncontrolled Keywords: | ANX005,Eculizumab,Guillain-Barré syndrome,Immunoglobulin,Monoclonal antibody,Plasma exchange,Pharmacology,Clinical Neurology,Pharmacology (medical) |
Publication ISSN: | 1878-7479 |
Last Modified: | 07 Oct 2025 07:21 |
Date Deposited: | 06 Oct 2025 16:10 |
Full Text Link: | |
Related URLs: |
http://www.scop ... tnerID=8YFLogxK
(Scopus URL) |
PURE Output Type: | Review article |
Published Date: | 2022-06-01 |
Accepted Date: | 2022-05-20 |
Authors: |
Rajabally, Yusuf A.
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