Late intravenous immunoglobulin treatment in patients with Kawasaki disease

• Published in: Pediatrics (Evanston) 2012-02, Vol.129 (2), p.e291-e297
• Main Authors: Muta, Hiromi, Ishii, Masahiro, Yashiro, Mayumi, Uehara, Ritei, Nakamura, Yosikazu
• Format: Article
• Language: English
• Subjects: Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Bilirubin - blood; C-Reactive Protein - metabolism; Cells; Cohort Studies; Coronary Aneurysm - diagnosis; Coronary Aneurysm - drug therapy; Coronary Aneurysm - immunology; Drug Administration Schedule; Drug evaluation; Drug therapy; Drugs; Female; Humans; Immunization, Passive; Immunoglobulins; Intravenous immunoglobulins; Japan; Kawasaki disease; Kawasaki syndrome; Leukocyte Count; Leukocytes; Lymphatic system; Male; Matched-Pair Analysis; Mucocutaneous Lymph Node Syndrome - diagnosis; Mucocutaneous Lymph Node Syndrome - drug therapy; Mucocutaneous Lymph Node Syndrome - immunology; Pediatrics; Product/Service Evaluations; Proteins; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2011-1704

To evaluate the effectiveness of intravenous immunoglobulin (IVIG) treatment of Kawasaki disease ≥10 days after illness onset. We selected patients initially treated with IVIG on days 11 to 20 in the database of the 20th nationwide survey in Japan. We then selected pair-matched control subjects of the same gender and age, who were initially treated with IVIG on days 4 to 8 with the same dose at the same institutions. We compared the proportions of additional treatments and coronary artery lesions (CALs) between the groups. We also compared fractional changes in various laboratory data before and after IVIG. Fractional change was defined as follows: (Y - X)/X, in which X represents the data before treatment and Y the data after treatment. One hundred fifty patients (75 pairs) were studied. The proportion of patients who received additional treatments among those given initial IVIG after days 10 was slightly lower than those treated earlier (12% vs 16%). The fractional changes in the white blood cell count, % neutrophils, and C-reactive protein were similar. Among all patients, the proportions of CALs during the convalescent phase were significantly higher in the late than in the early group (27% vs 1%). Among patients who had not developed CALs before initial treatment, the proportions with CALs during the acute phase were similar (8% vs 8%). IVIG treatment ≥10 days after illness onset achieves resolution of inflammation but was found to be insufficient for preventing CALs.