title: Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.
abstract: BACKGROUND
  Different immunoglobulin manufacturing processes may influence its effectiveness for Kawasaki disease. However, nationwide studies with longitudinal follow-up are still lacking. The aim of this study was to evaluate the comparative effectiveness of immunoglobulin preparations from a nationwide perspective.
  
  
  METHODS
  This is a nationwide retrospective cohort study with a new user design. Data came from the National Health Insurance Research Database of Taiwan. From 1997 to 2008, children under 2 years old who received immunoglobulin therapy for the first time under the main diagnosis of Kawasaki disease were enrolled. The manufacturing processes were divided into β-propiolactonation, acidification and those containing IgA. The endpoints were immunoglobulin non-responsiveness, acute aneurysm, prolonged use of anti-platelets or anti-coagulants, and recurrence.
  
  
  RESULTS
  In total, 3830 children were enrolled. β-propiolactonation had a relative risk of 1.45 (95% CI 1.08~1.94) of immunoglobulin non-responsiveness, however, the relative risks for acidification and containing IgA were non-significant. For acute aneurysms, acidification had a relative risk of 1.49 (95% CI 1.17~1.90), however the relative risks for β-propiolactonation and containing IgA were non-significant. For prolonged use of anti-platelets or anti-coagulants, β-propiolactonation had a relative risk of 1.44 (95% CI 1.18~1.76), and acidification protected against them both with a relative risk of 0.82 (95% CI 0.69~0.97), whereas the relative risk for containing IgA was non-significant. For recurrence, all three factors were non-significant.
  
  
  CONCLUSIONS
  The effectiveness of immunoglobulin may differ among different manufacturing processes. β-propiolactonation had a higher risk of treatment failure and prolonged use of anti-platelets or anti-coagulants. Acidification may increase the risk of acute coronary aneurysms.
authors: Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Ming-Chih
authors: MC
authors: Lin
authors: Yun-Ching
authors: YC
authors: Fu
authors: Sheng-Ling
authors: SL
authors: Jan
authors: Mei-Shu
authors: MS
authors: Lai
mesh_terms: D018572:Disease-Free Survival; D004339:Drug Compounding; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000494:pharmacology; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000628:therapy*; D016017:Odds Ratio; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017211:Treatment Failure
chemical_list: D016756:Immunoglobulins, Intravenous
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