Effects of IVIG Treatment and Neurofilament Light Chains as Prognostic Indicators of Guillain-Barre Syndrome

Guillain-Barre syndrome (GBS) is a rare autoimmune disease resulting from the breakdown of neurons in the peripheral and central nervous systems.¹ These breakdowns cause muscle weakness, difficulty breathing, and in severe cases, the inability to walk or complete loss of bodily functions.¹ During the autoimmune breakdown process, neurofilament light chains (NfL), a neuronal scaffolding protein, break off from the neuron and flood the body's cerebral spinal fluid and peripheral blood.^2,3

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Researchers from Erasmus MC Hospital in Rotterdam, Netherlands, investigated the prognostic and diagnostic value of NfL in GBS. Previously, studies demonstrated increasing evidence for using NfL as a biomarker, but no studies have identified NfL’s importance during the acute phase of GBS. Elevations in serum NfL levels after 1 week of intravenous immunoglobulin (IVIG) developed into more threatening patient outcomes and severe disability.³

During the study, researchers also analyzed the effects of IVIG on serum NfL levels and patient outcomes. Initial treatment with IVIG dilutes harmful antibodies and impairs autoimmune breakdown on neurons, a mainstay in GBS treatment.¹ Researchers found that a second IVIG treatment had no impact on clinical course. Patients with 2 IVIG treatments had no statistically significant improvement in clinical outcomes compared to patients with 1 IVIG treatment and placebo.³

The investigators discussed the importance of properly predicting a patient’s clinical course, including accurately classifying a patient’s GBS subtype. Currently, health care professionals use prognostic models that factor in demographics and other clinical predictors to analyze future outcomes.³

With these new prognostic models, health care professionals can accurately modify supportive care into more sophisticated treatment plans for individual patients and educate patient families about what to expect. Additionally, future researchers can use NfL as an intermediate endpoint to enhance trial efficiency.³

This study carried some limitations that were acknowledged by the researchers. During a normal GBS disease course, NfL may normalize after continued treatment. In this study, investigators did not collect or analyze NfL levels between weeks 4 and 12 of treatment, limiting the ability to identify clinical course or GBS classification.³

The researchers suggested using larger sample sizes and increasing sample count during treatment to identify the true nature of NfL as a prognostic indicator. Despite these concerns, the study authors concluded that dynamic serum NfL levels correspond with disease severity.³

REFERENCES

1. Guillain-Barré Syndrome. National institute of Neurological Disorders and Stroke (NINDS). Accessed August 2, 2024. https://www.ninds.nih.gov/health-information/disorders/guillain-barre-syndrome

2. Altmann P, De Simoni D, Kaider A, et al. Increased serum neurofilament light chain concentration indicates poor outcome in Guillain-Barré syndrome. J Neuroinflammation. 2020;17(1):86. Published 2020 Mar 17. doi:10.1186/s12974-020-01737-0

3. van Tilburg SJ, Teunissen CE, Maas CCHM, et al. Dynamics and prognostic value of serum neurofilament light chain in Guillain-Barré syndrome. EBioMedicine. 2024;102:105072. doi:10.1016/j.ebiom.2024.105072