Beyond the Centrifuge: Is FcRn Inhibition Ready to Replace Apheresis in Treatment of Guillain–Barré Syndrome?

ABSTRACT

Despite the available treatment modalities such as intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE), many Guillain–Barré Syndrome (GBS) patients suffer from incomplete recovery and persistent paralysis. This paper evaluates the potential of targeting the neonatal fragment crystallizable receptor to reduce pathogenic immunoglobulin G (IgG) as a novel therapeutic approach. By reviewing current clinical evidence including data from 10 recent case reports and case series across various GBS presentations, we found that FcRn inhibitors such as efgartigimod consistently led to significant motor recovery even in refractory cases where standard treatments had already failed. Unlike broad immunosuppression, this mechanism specifically targets IgG degradation while sparing other immunoglobulin classes. Our analysis suggests that FcRn inhibition is a promising and clinically viable strategy that complements the current treatment modalities for management of GBS and GBS variants.