Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose☆,☆☆,★
Section snippets
Methods
We identified 15 published multicenter controlled studies of IVGG treatment of acute KD written in English or Japanese since 1984.3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Because the evaluation of echocardiograms can be somewhat subjective, ideally they should be interpreted by readers unaware of the patient's treatment assignment to avoid bias. We selected 7 of the 15 studies for analysis of the effect of IVGG and aspirin on prevalence of CAA because they were multicenter,
Moderate-dose aspirin plus IVGG
Data for 868 Japanese patients treated with moderate-dose aspirin (30 to 50 mg/kg per day) in five multicenter trials (in three reports) were available for analysis.10, 15, 16 The prevalence of CAA at the subacute stage was 26.8% with aspirin alone, 18.1% with total IVGG dose < 1 gm/kg, 17.3% with total IVGG of 1.0 to 1.2 gm/kg, and 5.3% with total IVGG dose of 2 gm/kg; corresponding figures at the convalescent stage were 17.5%, 13.5%, 9.8%, and 3.5% respectively. The prevalence of CAA after
Discussion
The first published (in Japanese) preliminary report of IVGG treatment of KD in February 1983 was a series of five patients treated with 400 mg/kg for 5 days in an uncontrolled trial by Furusho et al.20 The first controlled study of the effect of IVGG on KD was described in Japanese by Kondo et al.21 in July 1983. These investigators studied 41 patients with KD treated by the eighth illness day, comparing 19 patients who received a single infusion of 100 mg/kg intact IVGG plus aspirin with 22
Acknowledgements
We thank Edwin Chen, PhD, for statistical advice.
References (27)
- et al.
Kawasaki disease
Pediatr Clin North Am
(1995) - et al.
High-dose intravenous gamma globulin for Kawasaki disease
Lancet
(1984) - et al.
High-dose gamma globulin therapy for Kawasaki disease
J Pediatr
(1987) - et al.
Treatment of Kawasaki syndrome: a comparison of two dosage regimens of intravenously administered immune globulin
J Pediatr
(1990) - et al.
Late intravenous gamma globulin treatment in infants and children with Kawasaki disease and coronary artery abnormalities
Am J Cardiol
(1991) Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children [in Japanese]
Arerugi
(1967)- et al.
A controlled study of gamma globulin treatment for Kawasaki disease [in Japanese]
J Jpn Pediatr Soc
(1986) - et al.
The treatment of Kawasaki syndrome with intravenous gamma globulin
N Engl J Med
(1986) - et al.
Japanese gamma globulin trials for Kawasaki disease
- et al.
High-dose gamma globulin therapy for Kawasaki disease; trial of 200 mg/kg/day for 3 days [in Japanese]
J Jpn Pediatr Soc
(1987)
High-dose gamma globulin therapy for Kawasaki disease [in Japanese]
J Jpn Pediatr Soc
Multicenter randomized controlled study of intravenous immunoglobulin in Kawasaki disease [in Japanese]
J Jpn Pediatr Soc
Clinical trial of single-dose intravenous gamma globulin in acute Kawasaki disease
Am J Dis Child
Cited by (306)
Kawasaki disease in children with Bacillus Calmette-Guérin scar reactivity: Focus on coronary outcomes
2023, Journal of the Formosan Medical AssociationFrench national diagnostic and care protocol for Kawasaki disease
2023, Revue de Medecine InterneCost-effectiveness analysis of infliximab for the treatment of Kawasaki disease refractory to the initial treatment: A retrospective cohort study
2022, Journal of CardiologyCitation Excerpt :However, CAA can be prevented by suppressing inflammation early in acute phase treatment. Initiation of intravenous immunoglobulin (IVIG) (2 g/kg) within 10 days of fever onset has been confirmed to reduce the risk of CAA by approximately 20% (from 25% to <5%) [4–8]. High-dose IVIG (2 g/kg) or combination with steroid therapy as 1st line treatment has reduced rates of cardiac sequelae in Japan [9].
Autoimmune Encephalitis: Distinguishing Features and Specific Therapies
2022, Critical Care ClinicsTreatment and Coronary Artery Aneurysm Formation in Kawasaki Disease: A Per-Day Risk Analysis
2022, Journal of Pediatrics
- ☆
From the Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois, and the Department of Pediatrics, School of Medicine, Chiba University, Chiba, Japan.
- ☆☆
Reprints not available from author.
- ★
0022-3476/97/$5.00 + 0 9/21/81360