Summer 2000

Y2K Diagnostic criteria
for CIDP


The Cochrane collaboration:
Role of corticosteroids for GBS




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The Cochrane Collaboration:
Role of Corticosteroids for Guillain-Barré Syndrome

©Joel Steinberg 2000

As early as 1972, a British statistician, Archie Cochrane recognized the lack of systematic reviews of the medical literature to provide guidance in medical care. Cochrane's initial systematic review was directed at assessing prenatal care. He sought to determine if there was information in the literature that could be used to improve care during pregnancy and childbirth, to improve the outcome for the mother and infant. Several large and well respected organizations appreciated the potential value of the Cochrane approach to optimize medical care. These organizations included Cochrane's base of operation in the United Kingdom, the World Hea1th Organization, and the United States Public Heath Service. Cochrane's work led to publication in 1992 of “Effective Care of the Newborn infant”. The recognition of the value of a systematic review of control trials led to the opening of the first ''Cochrane Centre'' in Oxford, United Kingdom, in October 1992. That centre is now called ''The UK Cochrane Centre'' and there are several others around the world, including Baltimore, Maryland in 1998, underage leadership of Professor Richard Hughes, of Guy's Hospital in London, the ''Neuromuscular Diseases Group'' was created.

A word of explanation is warranted. A controlled trial is a study in which all patients presenting with the same disorder are randomly divided into two separate groups. One group is given either no special care or a currently accepted standard care. This acts as the control group, or the non-treated group relevant to a new therapy. The second group is given a treatment that is suspected of being helpful. Patent outcomes for the treatment group are then compared to patient outcomes in the controlled group. For Guillain-Barré Syndrome, various possible outcomes can be compared. For example, one can determine the effects of non-treatment versus a new treatment on a patient's improvement in strength or walking ability at four weeks after treatment began, and also later, at one year after treatments began.

In 1999, the Cochrane group published an assessment of the role of corticosteroids for treating Guillain-Barré Syndrome. The report was authored by Professor R. Hughes and Dr. F. van der Meche. Six randomized trials were found in the medical literature and were evaluated. Randomization is a method of placing a patient in either the control (non-treated) group or treated group, in an unbiased mannerism help assure that the results of the study will be reliable. The object of the study was to determine if corticosteroids could hasten recovery and reduce long term problems from Guillain-Barré Syndrome.

The study came to the following conclusions. At four weeks after beginning treatment, both the non-treatment and treatment groups of patients had similar improvement in their disability. Thus at least at the end of the month, corticosteroids did not show evidence of benefit.

The study also analyzed the effects of corticosteroids on GBS patients at twelve months after treatment began. That data showed less improvement of strength, walking, etc. in treated patients compared to the non-treated patients.

The authors concluded, as a result of analyzing the six randomized trials, that corticosteroids should not be used for treatment of Guillain-Barré Syndrome. However, if a patient with GBS needs steroids to treat some other problem that probably should be done, with negligible risk of harm.

It is worth noting that corticosteroids can be invaluable in the treatment of some inflammatory disorders, such as systemic lupus erythematosis, rheumatoid arthritis, and so forth. However, corticosteroids are not without potential and quite significant complications, which are many. These include steroid induced diabetes, thinning of the bones osteoporosis, thinning of the skin and easy trauma or tears, and substantial emotional changes such as irrational behavior. Thus, physicians usually are quite careful about determining when corticosteroids should be used.

Also, the term ''corticosteroid'' is often known by many other terms and can thus be confusing to patients. Other commonly used terms include steroids, prednisone, prednisolone, methyl-prednisolone, and cortisol. These are all different names for corticosteroids, which is a totally different drug from the type of steroids used to build muscle in athletes and animals. Those are called androgenic steroids.

The Cochrane Neuromuscular Disease Group is currently assessing other studies of potential interest to our readership. These include effect of steroids for chronic inflammatory demyelinating polyneuropathy (CIDP), plasma exchange for GBS and intravenous immunoglobulin for CIDP. Eventually, the Group plans to assess published studies in other areas of treatment for GBS and CIDP.

The newsletter of the Cochrane Neuromuscular Disease Group is edited by Professor D. Annane, Professor R Hughes, Dr. R Miller and Dr. M. Rose, and coordinated by Louisa Dunn, (email: Louisa.dunn@kcl.ac.uk).

The GBS Foundation International appreciates the work of Professors Annane, Hughes, Miller, Rose, and their associates. All interested parties (physicians, researchers, patients, families, etc.) are invited to learn more about the Cochrane Neuromuscular Disease Group by contacting Louisa Dunn at the above e-mail address, or, under the term ''Cochrane'' an internet search will readily provide a wealth of information on the Cochrane Collaboration.

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