Journal Article

A randomized prospective study on the use of 2 g-IVIG or 1 g-IVIG as therapy for Kawasaki disease

Ozawa, Sei-ichiro, Niboshi, Ayumi, Yoshihara, Takao, Morimoto, Yoshiko, Nishiki, Tesuo, Sakata, Koichi, Kazuta, Kikuko, Yamamoto, Toru, Horii, Yoshihiro, Hamaoka, Kenji, Kido, Sachiko, Kamiya, Yasutaka, Nakagawa, Yumi

2007

Overview

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.

• Publisher: Springer,Springer Nature B.V,National Library of Medicine - MEDLINE Abstracts
• Subject: Aspirin / Biological and medical sciences / Body temperature / Child / Child, Preschool / Coronary Disease - etiology / Coronary Disease - prevention & control / Coronary vessels / Dose-Response Relationship, Drug / Fees, Pharmaceutical / Female / General aspects / Humans / Illnesses / Immunoglobulins, Intravenous - administration & dosage / Immunoglobulins, Intravenous - economics / Immunoglobulins, Intravenous - therapeutic use / Infant / Kawasaki disease / Male / Medical sciences / Mucocutaneous Lymph Node Syndrome - complications / Mucocutaneous Lymph Node Syndrome - drug therapy / Mucocutaneous Lymph Node Syndrome - physiopathology / Prospective Studies / Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis / Working groups