A randomized prospective study on the use of 2 g-IVIG or 1 g-IVIG as therapy for Kawasaki disease.
A single, 2 g/kg dose of immune globulin (IG), denoted 2 g-intravenous (IV)IG, has become a standard regimen for treating Kawasaki disease (KD) because of its highly preventive effect on coronary arterial lesions (CAL). However, IG is obtained from blood specimens, a drawback to many patients, and is also very expensive. This randomized prospective study reported here was carried out with the aim of developing a treatment regimen that would reduce the total dose of IG. The study tested two protocols (A: 2 g-IVIG; B: 1 g-IVIG) that included the strategy of administering additional IVIG to IVIG-resistant patients based on the criteria we described previously. In protocol A, an additional 2 g-IVIG was administered only once; in protocol B, the first additional IVIG was 1 g-IVIG and the second was 2 g-IVIG. One hundred and nine patients who were admitted before the seventh day of illness and had no CAL at the time of admission were enrolled in the study (protocol A: 54 patients; B: 55 patients). In the protocol A group, 7.4% (4/54) of the patients received 4 g/kg IG. In protocol B, 41.8% (23/55) were treated only with 1 g/kg IG, and 10.9% (6/55) received 4 g/kg IG. No significant differences were observed between the patients of the two subgroups receiving 4 g/kg IG in each protocol group. Discriminate analysis also suggested that 52.4% of the patients in the protocol A group could be treated only with 1 g/kg IG. On the other hand, no significant difference was observed in the incidence of aneurysms between patients in the protocol A group (1/54) and those in the protocol B group (4/55). Our protocol based on 1 g-IVIG, including additional IVIG, was assessed to be an effective treatment and to provide a considerably useful means to reduce the total dose of IG.
Sakata
Koichi
K
Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kyoto, Japan. info@sakata-clinic.com
Hamaoka
Kenji
K
Ozawa
Sei-Ichiro
S
Niboshi
Ayumi
A
Yoshihara
Takao
T
Nishiki
Tesuo
T
Nakagawa
Yumi
Y
Kazuta
Kikuko
K
Morimoto
Yoshiko
Y
Kamiya
Yasutaka
Y
Yamamoto
Toru
T
Horii
Yoshihiro
Y
Kido
Sachiko
S
D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005252:Fees, Pharmaceutical; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies
D016756:Immunoglobulins, Intravenous