Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy that usually follows an antecedent infection and causes acute neuromuscular paralysis. GBS is currently classified into the two major subtypes: a classical demyelinating type and axonal variant type. Whereas in Europe and North America demyelinating GBS is the major subtype, in East Asia and Central and South America, axonal GBS is found in 30\~65% of patients. Although the pathophysiology of GBS has not been fully understood, major advances have been made in understanding the pathophysiology particularly for the axonal form of GBS. It is now established that axonal GBS is caused by molecular mimicry of human gangliosides by the Campylobacter jejuni lipo-oligosaccharides. Autoantibodies bind to GM1 or GD1a at the nodes of Ranvier, activate complements, and disrupt sodium channel clusters and axo-glial junctions, resulting in the nerve conduction failure and muscle weakness. C. jejuni infection induces production of antibodies, which cross-react with gangliosides on the human nerve axolemma, and activate the complements, resulting in formation of membrane attack complex (MAC). The pathology leads to axonal degeneration. The standard treatments for GBS are plasma exchange and intravenous immunoglobulin and the disease progression reaches its nadir within 4 weeks. However, during the acute phase, 18-28 % of the patients require artificial ventilation and 4.1-6.3 % of the patients die of complications. Recovery takes several months or years, and 16.7-19.7 % of the patients still require aid to walk one year after onset. Because of such serious disability of GBS patients, an alternative novel therapy that can prevent death during acute phase or severe sequelae is needed. Eculizumab is a humanized monoclonal antibody of murine anti-human C5 antibody and specifically binds to the final activation complement component C5 and inhibits MAC formation by suppressing the cleavage reaction of C5 into C5a and C5b. The efficacy of eculizumab against GBS has been shown in a model of axonal GBS. At present, there are no animal models of demyelinating GBS. However, autopsy studies have shown that C3d and C5b-9 (MAC) are deposited on the Schwan cells, and therefore eculizumab can be effective also for demyelinating GBS. This clinical trial will be conducted to investigate the efficacy and safety of eculizumab for GBS to warrant future global clinical trials. Moreover, we also study the relationship between the efficacy and clinical subtypes of GBS, such as axonal or demyelinating form. Our trial will provide insights on whether the future global developmental plan should target the whole spectrum of GBS world-wide or focusing on Asia and South America.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
34
Nagoya University Hospital
Nagoya, Aichi-ken, Japan
Hokkaido University Hospital
Sapporo, Hokkaido, Japan
Kobe City Medical Center General Hospital
Kobe, Hyōgo, Japan
Kitasato University Hospital
Sagamihara, Kanagawa, Japan
Kindai University Hospital
Ōsaka-sayama, Osaka, Japan
National Defence Medical College Hospital
Tokorozawa, Saitama, Japan
Dokkyo Medical University Hospital
Mibu, Tochigi, Japan
Tokyo Medical and Dental University Hospital
Bunkyo-ku, Tokyo, Japan
Tokyo University Hospital
Bunkyo-ku, Tokyo, Japan
Keio University Hospital
Shinjuku-ku, Tokyo, Japan
...and 3 more locations
[Safety] Expressed frequency and severity of incidence of AE/SAEs after treatment with investigational product.
Time frame: 6 months
[Efficacy] Proportion of subjects who reach a score of FG2 or lower on the Hughes functional grading scale at week 4(Response Rate)
Time frame: 4 weeks
Proportion of subjects with improvement of one or more scores on the functional grading scale at each visit
Time frame: 6 months
Proportion of subjects who are able to walk unaided (FG2 or lower) at each visit
Time frame: 6 months
Duration required for improvement by at least one grade on the Hughes functional grading scale
Time frame: 6 months
Proportion of subjects who reach FG1 or 0 at week 24
Time frame: 6 months
Change in the FG score between peak disability score and the scores at each visit
Time frame: 6 months
Proportion of subjects with a clinically relevant improvement in the R-ODS score. An increase in the R-ODS score (0-48) converted to the centile metric score (0-100) by at least six points at each visit
Time frame: 6 months
Proportion of subjects with a clinically relevant improvement in ONLS. (a decrease in the ONLS score from baseline by at least 1 point) at each visit
Time frame: 6months
Proportion and frequency of subjects who require ventilatory support (F 5)
Time frame: 4 weeks
Duration of ventilatory support
Time frame: 8 weeks
Occurrence of relapse from the start of the IP(Investigational Product) administration period until the end of the post IP period
Time frame: 2 years
Overall survival from the start of the IP administration period until the end of the post IP period (OS)
Time frame: 6 months
Change in grip strength at each visit from baseline
Time frame: 6 months
Change in results of the manual muscle test (MMT score) at each visit from baseline
Time frame: 6 months
Change in the rate and results of below measures on the nerve conduction test parameter from baseline:Median and ulnar nerve 's CMAP amplitude, distal latency, F wave latency , SNAP amplitude, motor sensory nerve conduction velocity
Time frame: 6 months
Change in vital capacity and % vital capacity at each visit from baseline
Time frame: 6 months
Proportion of patients who undergo re-administration of IVIg
Time frame: 6 months
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