Treatment of Guillain-Barré syndrome with mycophenolate mofetil: a pilot study.

Guillain–Barre syndrome (GBS) is a severe, acute, immune mediated polyneuropathy. Intravenous immunoglobulin (IVIg) is the preferred treatment.1 The combination of methylprednisolone (MP) and IVIg does not provide significantly better improvement after 4 weeks if not adjusted for important prognostic factors.2 GBS is associated with many longlasting residual deficits. Autoantibodies, and B and T cells are likely to play a role in the different stages of GBS.3 Mycophenolate mofetil (MM) is a relatively new immune suppressive agent, suppressing mainly B and T lymphocytes, and is thought to be of additional value in immune mediated neurological conditions.4–6 We conducted an open label pilot study to assess the additional effect of MM, administered simultaneously with IVIg and MP. The aim was to investigate whether additional treatment with MM is safe in patients with GBS and, secondly, whether there is a tendency to improved outcome. The study was approved by the ethics committees of Erasmus Medical Centre and the nine participating centres. All patients fulfilled the criteria for GBS.7 Eligibility criteria were onset of weakness within 2 weeks before inclusion and inability to walk independently for 10 m (GBS disability score ⩾3). Exclusion criteria were age less than 18 years, GBS in the past, pregnancy, breast feeding, immunosuppressive treatment, antacids treatment, use of drugs interfering with the enterohepatic recirculation, suffering from immune mediated disease other than well regulated diabetes mellitus and severe concurrent disease.2 The group of patients treated with IVIg and MP in the Dutch IVIg-MP trial was used as the historical control group. …