Hughes,Cochrane,2004

Web site designed and maintained by Chris Cairns © SICS EBM Group 2004

GBS: Steroids don’t improve outcome

No evidence of benefit from use of steroids in GBS.

Citation/s: Corticosteroids for Guillain-Barre syndrome. Cochrane Database of Systematic Reviews 2004

Lead author's name and fax: R Hughes, Professor of Neurology, Department of Clinical Neurosciences, Guy's King's and St Thomas' School of Medicine, London richard.a.hughes@kcl.ac.uk

Three-part Clinical Question: Do steroids improve outcome in patients with Guillain Barre syndrome?

Search Terms: 1 guillain barre syndrome (16) (in Cochrane Database of Systematic Reviews)

The Review:

Data Sources: : Cochrane Library, Medline, Checked reference lists and contacted authors.

Study Selection: RCTs and quasi-randomised studies involving adults and children with GBS of all degrees of severity. Any for of steroid or ACTH preparation.

Data Extraction: Method of allocation, allocation concealment, patient blinding, observer blinding, explicit diagnostic criteria, follow-up. Intervention: type and duration. Primary endpoint: improvement in disability grade on a commonly used seven point (GBS disability) scale four weeks after randomisation.

Multiple independent reviews of individual reports. Tested for heterogeneity.

The Evidence:

6 eligible trials (total of 382 patients). Comparing steroid therapy versus supportive therapy alone.

Primary endpoint: improvement in disability grade on a commonly used seven point (GBS disability) scale four weeks after randomisation. No difference.

Secondary endpoint: No evidence of any differences.

In the largest trial: hypertension more common in control group compared to methylprednisolone treated group.

Comments:

1. No evidence of benefit from use of steroids in GBS.

2. Mechanism of increased rate of hypertension in control patients not clear: remember this is a disease orientated endpoint (physiological measurement) rather than patient orientated endpoint (clinically important).

3. Pooled mortality rate 5%.

EBM Comments:

1) Do the methods allow accurate testing of the hypothesis? - YES

2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? - YES

3) Are conclusions valid in light of the results? - YES

4) Did results get omitted, and why? - NO

5) Did they suggest areas of further research? Acknowledged (at that time) the ongoing RCT.

6) Did they make any recommendations based on the results and were they appropriate?

7) Is the study relevant to my clinical practice? GBS is condition seen infrequently in ICU. Useful data on demographics and outcome of GBS.

8) What level of evidence does this study represent? Level 1+ evidence

9) What grade of recommendation can I make on this result alone? Grade A recommendation

10) What grade of recommendation can I make when this study is considered along with other available evidence? This is supported by recent RCT.

11) Should I change my practice because of these results? No evidence of benefit from steroids. If a patient requires a corticosteriod for another reason - it will probably not worsen the GBS. Mechanism of increased rate of hypertension in control patients not clear: remember this is a disease orientated endpoint (physiological measurement) rather than patient orientated endpoint (clinically important).

12) Should I audit my current practice because of these results? Difficult: low incidence, limited data to collect / available to collect for individual practitioner unit; unless solely neurological service.

Appraised by: Malcolm Daniel, Department of Anaesthesia, Glasgow Royal Infirmary, G4 0SF.; Monday, June 28, 2004

E-mail: md23s@udcf.gla.ac.uk

Kill or Update By: August 2007

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