Comparison of different types and regimens of intravenous immune globulin (IVIG) in patients with Kawasaki disease

Object: To evaluate the effect of different types and regimens of high-dose intravenous immune globulin (IVIG) on patients with Kawasaki Disease. Patients: From June 1994 to May 2002, 120 patients who met the diagnostic criteria of Kawasaki Disease (KD) at our institution were reviewed. Of them, 99 who had complete data were enrolled in this study. Before IVIG therapy, 25 (25.3%) of 99 patients had coronary artery involvement. Methods: Patients with KD were given a different brand and dosage of IVIG when available in the hospital in random order. They were divided randomly into 4 groups with different types and regimens of high-dose IVIG. Group I (33 cases)- G regimen, 400 mg/kg/day x 5 days; Group II (47 cases)- G regimen, 2 gm/kg x 1 dose; Group III (10 cases)- I regimen, 400 mg/kg/day x 5 days; Group IV (9 cases)- I regimen, 2 gm/kg x 1 dose. Patients' data were collected including: 1. age and sex; 2. symptoms and signs; 3. fever lasting days after IVIG; 4. echocardiographic findings (before IVIG, at acute stage, at convalescent stage, and long term follow-up); 5. retreatment with IVIG. Results: 1. There were some differences in the clinical features, including sex, age, duration of fever before administration of IVIG, and diagnostic criteria of Kawasaki Disease among the 4 groups; 2. The durations of fever lasting after administration of IVIG were 3.9 ± 2.2, 2.8 ± 1.4, 4.3 ± 2.5, and 2.0 ± 1.3 days in Groups I, II, III and IV, respectively; 3. Two-dimensional echocardiographic evidence of coronary arterial dilatation/aneurysm detected before IVIG in Groups I, II, III and IV were, respectively, 36.4%, 40.4%, 30.0%, and 11.1%, at acute stage were 60.6%, 44.7%, 20%, and 22.2%, at convalescent stage were 12.1%, 17.0%, 0%, and 0%, and at long-term follow-up were 12.1%, 12.8%, 0%, and 0%. 4. The rates of retreatment with IVIG were 9.1%, 8.5%, 10%, 11.1% in Group I, II, III and IV, respectively. Conclusions: 1. Treatment of Kawasaki Disease with the regimen of 2 gm/kg x one dose of IVIG had a better effect to shorten the duration of fever than that with 400 mg/kg/day x 5 days. 2. G and I regimens seemed to make a difference in prevention of coronary dilation/aneurysm at acute stage, although the difference was without statistical significance; and there were no statistical differences in convalescent stage, long-term follow-up and retreatment, even for different dosages and brands. 3. If the patients with coronary abnormalities before IVIG were excluded, coronary abnormality prevention rates were 50.0%, 49.2%, 100%, and 100%, respectively, by the four different regimens of IVIG.