{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T18:17:30Z","timestamp":1778696250756,"version":"3.51.4"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004243","name":"Prinses Beatrix Spierfonds","doi-asserted-by":"publisher","award":["W.OR19\u201024"],"award-info":[{"award-number":["W.OR19\u201024"]}],"id":[{"id":"10.13039\/501100004243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Intravenous immunoglobulin (IVIg) is an effective treatment for Guillain\u2013Barr\u00e9 syndrome (GBS), but recovery varies between patients. This study aims to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of a single and a second IVIg dose (SID) in patients with GBS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were analyzed from the SID\u2010GBS trial, a double\u2010blind, randomized, placebo\u2010controlled study. Patients with poor prognosis (modified Erasmus GBS Outcome Score, mEGOS \u22656) after a standard course of IVIg (0.4\u2009g\/kg for 5\u2009days) were randomized to receive either SID or placebo. Serum IgG levels were measured at standard serial time points and clinical outcomes were assessed using the GBS disability score and Medical Research Council sum score. PK modeling was performed to predict IVIg exposure and its association with clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Serum IgG concentration after a single and double course of IVIg was variable, but accurately described by the current PK model. Lower \u0394IgG and IVIg exposure were associated with poorer clinical outcomes. SID increased the IgG concentration, but did not result in an improvement in clinical outcome. Serious adverse events, including thromboembolic events, occurred more frequently in the SID group and were associated with lower IVIg exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>SID increases serum IgG levels in GBS patients as predicted by the current PK model, but does not improve clinical outcomes and increases the risk of serious adverse events. Model\u2010informed precision dosing may guide individualization of treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.52313","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T10:40:40Z","timestamp":1741948840000},"page":"966-975","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["If it does not help, it might hurt: Pharmacodynamics of a second IVIg course in Guillain\u2013Barr\u00e9 syndrome"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3983-9797","authenticated-orcid":false,"given":"Sander J.","family":"van Tilburg","sequence":"first","affiliation":[{"name":"Department of Immunology, Erasmus MC University Medical Center  Rotterdam The 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