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IVIG most effective in Kawasaki patients when given before 10-day mark

Muta H. Pediatrics. 2012;129:291-297

Treating patients with Kawasaki disease with intravenous immunoglobulin 10 or more days after illness onset can be effective in treating inflammation, but a delay in treatment is less effective in preventing coronary artery lesions. Therefore, intravenous immunoglobulin treatment should begin as soon Kawasaki disease is suspected, according to a study published online.

Hiromi Muta, MD, and colleagues used Japan’s 20th nationwide Kawasaki disease survey and pair-matched 150 patients. The researchers sent a questionnaire to treating hospitals to gather information about principal symptoms, treatment, laboratory parameters of intravenous immunoglobulin (IVIG) and coronary artery lesions (CALs). Patients must have had five of six principal Kawasaki disease symptoms to be considered diagnosed for the survey. Researchers measured the effectiveness of the treatment by comparing the need for additional treatment, the development of CALs and fractional changes in laboratory parameters before and after IVIG.

Twelve percent of those patients who were initially treated with IVIG within 4 to 8 days needed additional treatment vs. 16% of those patients treated in the 11- to 20-day range. The researchers said “fractional changes in the white blood cell count, percent neutrophils, and C-reactive protein were similar.”

CALs were much higher (27%) in the delayed treatment group vs. the group that had been treated within 4 to 8 days (1%). Patients who did not develop CALs before initial treatment in both groups had similar proportions of them during the acute phase, at a rate of about 8%.

Disclosure: The researchers report no relevant financial disclosures.

Japanese epidemiologists have carried out nationwide surveillance of Kawasaki disease cases every 2 years for more than 40 years. The 20th such survey covered 2007-08, and data were used to assess the degree of benefit of initial IVIG therapy that is administered late, on illness days 11-20, compared to patients treated with IVIG by the 10th day of illness. Given the limitations of using this data source, the investigators concluded that, as previously thought likely, later administration of IVIG is generally effective in terminating the inflammatory activity of acute stage KD (fever, etc), but is not adequate to prevent development of coronary artery abnormalities. These data emphasize that whenever possible, institution of therapy by the 10th illness day is clearly important for maximal prevention of coronary artery abnormalities in Kawasaki disease patients.

Stanford T. Shulman, MD
Infectious Diseases in Children Editorial Board

Disclosure: Dr. Shulman reports no relevant financial disclosures.

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