To assess the efficacy of Intravenous Immunoglobulins (IVIG) in adults with axonal Guillain–Barré syndrome (GBS).

GBS can be classified as demyelinating and axonal. The axonal variants present with worse symptomatology and poor response to treatment. The mainstay of therapy is IVIG and although several studies demonstrated its efficacy in GBS; little is known about its effect in patients with the axonal variants.

A systematic search was performed in PubMed, Embase, SCOPUS, Web Of Science, and Google Scholar for studies conducted up to April 2024. Studies evaluating the efficacy of IVIG in adults with an axonal variant of GBS were selected. Primary endpoints included the proportion of patients with clinical improvement (a change of at least 1 point in the GBS disability scale) at 4 weeks and the proportion that were able to walk independently at 6 months. Quality assessment was performed using Cochrane Risk of Bias 1 tool for nonrandomized studies. A single-arm and a random effects model meta-analysis of proportions were conducted, using the I2 for statistical heterogeneity. GRADE criteria were used to identify the certainty of evidence.

A total of 1598 studies were screened, and 13 studies were selected, representing a total of  358 patients with axonal GBS. All of them were observational studies. The pool proportion for clinical improvement at 4 weeks was 33% CI 95% [24%, 44%], and for achieving independent walking at 6 months was 75% CI 95% [60%, 85%]. Only two studies reported IVIG vs Plasmapheresis showing a pooled OR of 3.59  CI 95% [0.71 , 18.02 ]. Quality assessment showed a low-medium risk of bias.

With a low certainty, our findings suggest that IVIG could improve functional outcomes in patients with axonal GBS. There was no significant difference of efficacy between IVIG and plasmapheresis; however, larger randomized controlled trials are needed to confirm this finding.