Corticosteroid Therapy in Guillain-Barré Syndrome: Clinical Impact and Current Evidence

Abstract

Introduction: Guillain-Barré syndrome (GBS) is a rapidly progressive acute paralytic neuropathy. It is a post-infectious autoimmune disorder, commonly triggered by Campylobacter jejuni, causing a potentially severe immune response that attacks peripheral nerves. Global mortality is estimated at approximately 8%, and about 20% of diagnosed patients experience long-term persistent neurological disability. In Chile, the clinical management of GBS follows international guidelines, although challenges remain in ensuring timely and equitable access to treatment. Objective: To gather evidence on the use of corticosteroids in the management of GBS. Methodology: Secondary exploratory review study. The Web of Science database was used, and 13 full-text articles were analyzed. Results: Corticosteroids administered as monotherapy do not accelerate GBS recovery nor improve long-term prognosis. Four studies reported that the development of insulin-dependent diabetes was significantly more frequent in patients treated with corticosteroids. The incidence of hypertension was less frequent. Discussion: Oral corticosteroid therapy was not only ineffective but also associated with worse clinical outcomes, with significantly higher mean scores on the disability scale. In contrast, intravenous corticosteroid therapy showed a more neutral profile, without significant benefits but also without major adverse effects on recovery. Conclusion: Corticosteroids should not be used as monotherapy in GBS management. Adverse events, such as the increased risk of insulin-dependent diabetes, reinforce the need to avoid their use. Intravenous immunoglobulin and plasma exchange remain the therapeutic options with proven efficacy.