Comparison of length of hospital stay between treatment with plasma exchange versus IVIg in mild Guillain-Barré Syndrome. (P7.064)

Objective: To determine whether there is a difference in length of hospital stay (LOS) between groups of patients with mild Guillain-Barre Syndrome (GBS) treated with intravenous immunoglobulin (IVIg) versus plasma exchange (PLEX). Background: Several studies have established comparable efficacy of PLEX and IVIg in the treatment of GBS. A full treatment with PLEX may be delayed due to need for large vessel access or prolonged due to reduced fibrinogen levels or limited availability. As a standard IVIg dose can be administered over 2 - 5 days, IVIg may offer advantages in patients without respiratory or bulbar compromise, who could otherwise be discharged immediately upon completion of treatment. Methods: A retrospective review of charts from patients with mild (Hughes score 1 or 2) GBS was performed. Inclusion required acute progressive weakness with or without sensory disturbance and diminished tendon stretch reflexes, with support of either A) cerebrospinal fluid cytoalbuminologic disassociation; B) electrodiagnostic evidence of acquired demyelinating neuropathy; or C) both. Number of days from first treatment to discharge defined LOS. Treatment was determined at the discretion of the treating physician, in conjunction with patient preference and was not randomized or blinded. Results: Treatment groups (IVIg: N = 12; PLEX: N = 8) did not differ with regard to age or gender. The IVIg treatment group had shorter LOS (IVIg = 8.5 ± 4.4 days, PLEX = 13.6 ± 6.7; p =0.05), while percent discharged under 6 days favored IVIg but was not significant (IVIg = 33[percnt], PLEX = 12.5[percnt]; p = 0.60). Conclusion: Although our strict inclusion criteria limited our study size, one primary outcome showed a significant difference in LOS favoring IVIg, while the other trended toward IVIg. Given comparable efficacy of IVIg and PLEX, use of IVIG in this subpopulation with mild GBS may offer an advantage by reducing LOS. Disclosure: Dr. Klinov has nothing to disclose. Dr. Campellone has received personal compensation for activities with Allergan, Inc. and Teva as a speaker.