Summary of findings for the main comparison. Corticosteroid versus control for Guillain‐Barré syndrome.
| Corticosteroid versus control for Guillain‐Barré syndrome | ||||||
| Patient or population: people with Guillain‐Barré syndrome Settings: hospital Intervention: corticosteroid versus control | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Corticosteroid | |||||
| Disability grade change after 4 weeks GBS disability grade. Scale from: 0 to 6 | The mean disability grade change after 4 weeks in the control groups was ‐0.89 GBS disability grade change1 | The mean disability grade change after 4 weeks in the intervention groups was 0.36 lower (0.88 lower to 0.16 higher) | ‐ | 587 (6 studies) | ⊕⊕⊕⊝ moderate2 | Lower change in disability grade means less improvement so the corticosteroid group did worse, but not significantly |
| Disability grade change after 4 weeks ‐ oral regimens GBS disability grade. Scale from: 0 to 6 | The mean disability grade change after 4 weeks ‐ oral regimens in the control groups was ‐1.33 GBS disability grade1 | The mean disability grade change after 4 weeks ‐ oral regimens in the intervention groups was 0.82 lower (1.47 to 0.17 lower) | ‐ | 120 (4 studies) | ⊕⊝⊝⊝ very low3,4,5 | Lower change in disability grade means less improvement so the corticosteroid group did worse, significantly in this analysis |
| Disability grade change after 4 weeks ‐ intravenous regimens GBS disability grade. Scale from: 0 to 6 | The mean disability grade change after 4 weeks ‐ intravenous regimens in the control groups was ‐0.78 GBS disability grade1 | The mean disability grade change after 4 weeks ‐ intravenous regimens in the intervention groups was 0.17 higher (0.39 higher to 0.06 lower) | ‐ | 467 (2 studies) | ⊕⊕⊕⊝ moderate6 | Higher change in disability grade means more improvement so the corticosteroid group did better, but not significantly |
| Improvement by ≥ 1 grades after 4 weeks GBS disability grade scale | 543 per 10007 | 586 per 1000 (505 to 673) | RR 1.08 (0.93 to 1.24) | 567 (5 studies) | ⊕⊕⊕⊝ moderate8 | Slightly more corticosteroid participants improved but the difference was not significant |
| Death or disability after 1 year | 92 per 10007 | 139 per 1000 (84 to 230) | RR 1.51 (0.91 to 2.5) | 491 (3 studies) | ⊕⊕⊕⊝ moderate9 | More corticosteroid participants had died or were disabled but the difference was not significant |
| Adverse events ‐ diabetes mellitus requiring insulin | 56 per 10007 | 124 per 1000 (67 to 231) | RR 2.21 (1.19 to 4.12) | 467 (2 studies) | ⊕⊕⊕⊕ high | Significantly more corticosteroid participants needed insulin |
| Adverse events ‐ hypertension | 117 per 10007 | 18 per 1000 (6 to 48) | RR 0.15 (0.05 to 0.41) | 467 (2 studies) | ⊕⊕⊕⊕ high | Significantly fewer corticosteroid participants developed hypertension, the opposite of what was expected. See Discussion |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; GBS: Guillain‐Barré syndrome; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Based on mean scores of control groups. 2 We downgraded once for imprecision. 95% CI consistent with either a clinically significant 0.88 grade less improvement with corticosteroids or slight benefit. High heterogeneity but not downgraded because explained by route of administration. 3 We downgraded because of limitations in study design. 3 of 4 trials had inadequate allocation concealment and 3 of 4 inadequate blinding. 4 We downgraded for heterogeneity; the I2 test for heterogeneity was 51%. 5 We downgraded for imprecision. Wide CIs consistent with no difference or clinically significant worse outcome with corticosteroids. 6 We downgraded for limitations in design and implementation. In 1 of the trials, plasma exchange was used more often in the placebo group, which might have biased against detecting the efficacy of corticosteroids. See Discussion. 7 Based on mean of control participants in all studies. 8 We downgraded once for limitations in design and implementation of the studies. 3 of 6 trials had inadequate allocation concealment, 3 inadequate blinding and in 1, more placebo than corticosteroid participants received plasma exchange which might have biased against detecting an effect from corticosteroids.
9 We downgraded for limitations in design and implementation of the studies and for imprecision.