Zipper method is the emerging treatment option for severe Guillain-Barre syndrome related COVID-19.

Dear Editor;

We read the article of Hussain et al. with great interest [1]. The authors discussed very clearly a possible relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and Guillain-Barre syndrome (GBS) in a pathophysiological aspect which is mostly implicated by the cytokine release storm. Accordingly, severe SARS-CoV-2 infection and GBS share the similar immunological profile. Corticosteroids may be a good immunosuppressive choice for acting via multiple pathways. They have also pointed out that corticosteroids had not been observed enough in patients with severe GBS related Coronavirus disease 2019 (COVID-19) and should be kept in mind when other conventional therapies such as plasmapheresis and intravenous immunoglobulin (IVIG) failed.

While we appreciate the efforts of the authors, we think that preferred immunomodulatory therapy for those severe GBS patients should be Zipper Method. Zipper Method is the emerging treatment option for severe GBS patients [2]. Zipper Method consists of rigorous implementation of plasmapheresis and IVIG in an interpenetrating manner [3]. Plasmapheresis clears the autoantibodies and cytokines and prompt administration of IVIG after plasmapheresis session neutralizes antibodies that are regenerated and transited from tissue. The subsequent PE session sweeps away the soiled antibodies. This way of ranking leads to a consistency of both regimens augmenting each other's effect [3]. In severe COVID-19 patients the inflammatory mediators, especially IL-6 unveiling the cytokine chaos peak up around 7–14 days after onset. Early administration of plasmapheresis is also beneficial in alleviating COVID-19 related cytokine storm [4].

The Zipper Method reduces mortality, speeds up weaning from mechanical ventilation and shortens hospital stay with an excellent outcome in severe GBS patients with axonal involvement. Zipper Method provided shortened mechanical ventilation durations (mean 7 days) and length of stay (mean 18 days) in our case series of severe GBS with full recovery in 28 days [3].

We suggest Zipper Method as a further immunomodulation technique to be the preferred treatment option for COVID-19 related GBS patients as it promises better outcomes for both scenarios with severe presentation.

Funding

None.

Declaration of Competing Interest

None.