Kkkkfkfkfnnvmvmvm mmmm

Backgroundmmmxmmcmcmcmmcmxmxm Nxmm,z,z,...z;;z,,z,mx x xmx,, Despite available treatment with intravenous immunoglobulin !"!g#, morbidit$ and mortalit$ are considerable in patients with %uillain&Barr' s$ndrome %B(#. )ur aim was to assess whether meth$lprednisolone, when taken with !"!g, improves outcome when compared with !"!g alone. *ethods

+e did a double&blind, placebo&controlled, multicentre, randomised stud$, to which we enrolled patients who were unable to walk independentl$ and who had been treated within ,- da$s after onset of weakness with !"!g ./- g0kg bod$weight per da$# for 1 da$s. +e assigned 233 individuals to receive either intravenous meth$lprednisolone 1.. mg per da$; n4,,5# or placebo n4,,6# for 1 da$s within -7 h of administration of first dose of !"!g. Because age is an important prognostic factor, we split treatment groups into two age& groups8ie, $ounger than age 1. $ears, or 1. $ears and older. )ur primar$ outcome was an improvement from baseline in %B( disabilit$ score of one or more grades - weeks after randomisation. 9nal$sis was b$ intention to treat. :indings

+e anal$sed 221 patients. %B( disabilit$ scores increased b$ one grade or more in 57; 65 of ,,2# of patients in the meth$lprednisolone group and in 15; 53 of ,,3# of controls odds ratio <)=> ,/57, ?1; @! ./?6A2/77; p4./.5#. 9fter adBustment for age and degree of disabilit$ at entr$, treatment )= was ,/7? ?1; @! ,/.6A3/31; p4./.3#. (ide&effects did not differ greatl$ between groups.

!nterpretation

+e noted no significant difference between treatment with meth$lprednisolone and !"!g and !"!g alone. Because of the relevance of prognostic factors and the limited side&effects of meth$lprednisolone, the potential importance of combination treatment with the drug and !"!g, however, warrants further investigation.