Clinical responses of patients with Kawasaki disease to different brands of intravenous immunoglobulin.
OBJECTIVE
To determine whether different brands of intravenous immunoglobulin (IVIG) administered to children with Kawasaki disease (KD) result in different outcomes.


METHODS
We analyzed children with KD and divided them into 4 groups according to the brand of IVIG. A coronary artery abnormality (CAA) was defined as having a lumen diameter (inner border to inner border) of > or =3 mm in KD cases <5 years old and > or =4 mm in cases > or =5 years old, and giant aneurysm was defined as a lumen diameter > or =8 mm. Patients were considered nonresponsive to IVIG therapy if fever persisted longer than 2 days after completion of treatment and needed retreatment with IVIG.


RESULTS
We collected 437 cases, 29 (6.6%) were nonresponsive, 17 (3.9%) had CAA at convalescence, and 3 (0.7%) had giant aneurysm, 2 of whom had development of myocardial infarcts. Patients receiving Brand C IVIG, prepared with beta-propiolactone, had higher rates (10%, 9/93, P = .01) of CAA at convalescence and nonresponsiveness (13%, 12/93, P = .001); giant aneurysm occurred in 3/93 (3%) receiving Brand C IVIG and in 0/344 who received the other 3 brands (P = .008).


CONCLUSIONS
IVIG, prepared with beta-propiolactone, was most significantly associated with nonresponsiveness, CAA at convalescence, and giant aneurysm. Physicians should be cautious when using IVIG prepared with beta-propiolactone or enzyme digestion to treat KD.
Tsai
Ming-Han
MH
Division of Pediatric Infectious Diseases, Division of Taipei Pediatrics, Department of Pediatrics, Chang-Gung Children's Hospital, Taoyuan, Taiwan.
Huang
Yhu-Chering
YC
Yen
Meng-Hsiu
MH
Li
Chung-Chen
CC
Chiu
Cheng-Hsun
CH
Lin
Pen-Yi
PY
Lin
Tzou-Yien
TY
Chang
Luan-Yin
LY
D002648:Child; D002675:Child, Preschool; D003289:Convalescence; D003323:Coronary Aneurysm / Q000139:chemically induced; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous