Frontiers in immunology · 2026
Qualitative evaluation of pharmacological strategy for connective tissue diseases with Guillain-Barré syndrome: a systematic review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Yuan Gaodi, Yang Xiaomei, Xue Xue, Yang Jixian, Yu Zixia, Zhang Lang, Feng Jun, Luo Xiongyan, Zheng Xiaoli, Xiong Anji
Аннотация
OBJECTIVE: To systematically evaluate the pharmacological management of Guillain-Barré syndrome occurring in the context of connective tissue diseases (CTD-GBS) and to investigate the relative efficacy of different treatment regimens on neurological outcomes.
METHODS: Case reports and series regarding CTD-GBS were systematically retrieved from PubMed, Embase, and Web of Science databases. A Generalized Linear Mixed Model (GLMM) was utilized to assess independent associations between treatment regimens and neurological improvement, adjusting for key covariates including mechanical ventilation (as a baseline severity marker) and the year of publication.
RESULTS: A total of 105 CTD-GBS patients were identified, with systemic lupus erythematosus (SLE) being the most prevalent subtype (n=73). Multivariable GLMM analysis suggested that, compared to intravenous immunoglobulin (IVIG) monotherapy, intensive combination regimens specifically glucocorticoids combined immunosuppressants (GC + IS) demonstrated a potential association with higher odds of clinical improvement (adjusted Odds Ratio [aOR] = 30.90; 95% CI: 6.58-145.00; p < 0.001). Mechanical ventilation was identified as an independent negative predictor of recovery (aOR = 0.43; p = 0.037), while the year of publication did not significantly influence outcomes (p = 0.344). Descriptive analysis within the SLE-GBS subgroup corroborated these trends, with the GC + IS regimen achieving a clinical improvement rate of 88.9%.
CONCLUSION: Preliminary evidence suggests that intensive immunosuppressive combination therapy, notably GC + IS, may offer advantages over traditional IVIG monotherapy in improving short-term neurological outcomes for CTD-GBS patients. However, given the reliance on retrospective case-based evidence and the potential for confounding by indication, these findings should be interpreted as hypothesis-generating clinical clues rather than definitive guidelines. Future large-scale, prospective studies utilizing standardized functional assessment scales are urgently required to validate these preliminary observations.
METHODS: Case reports and series regarding CTD-GBS were systematically retrieved from PubMed, Embase, and Web of Science databases. A Generalized Linear Mixed Model (GLMM) was utilized to assess independent associations between treatment regimens and neurological improvement, adjusting for key covariates including mechanical ventilation (as a baseline severity marker) and the year of publication.
RESULTS: A total of 105 CTD-GBS patients were identified, with systemic lupus erythematosus (SLE) being the most prevalent subtype (n=73). Multivariable GLMM analysis suggested that, compared to intravenous immunoglobulin (IVIG) monotherapy, intensive combination regimens specifically glucocorticoids combined immunosuppressants (GC + IS) demonstrated a potential association with higher odds of clinical improvement (adjusted Odds Ratio [aOR] = 30.90; 95% CI: 6.58-145.00; p < 0.001). Mechanical ventilation was identified as an independent negative predictor of recovery (aOR = 0.43; p = 0.037), while the year of publication did not significantly influence outcomes (p = 0.344). Descriptive analysis within the SLE-GBS subgroup corroborated these trends, with the GC + IS regimen achieving a clinical improvement rate of 88.9%.
CONCLUSION: Preliminary evidence suggests that intensive immunosuppressive combination therapy, notably GC + IS, may offer advantages over traditional IVIG monotherapy in improving short-term neurological outcomes for CTD-GBS patients. However, given the reliance on retrospective case-based evidence and the potential for confounding by indication, these findings should be interpreted as hypothesis-generating clinical clues rather than definitive guidelines. Future large-scale, prospective studies utilizing standardized functional assessment scales are urgently required to validate these preliminary observations.