Effect of i.v. immunoglobulin in the first 4 days of illness in Kawasaki disease

Shiozawa, Yusuke; Inuzuka, Ryo; Shindo, Takahiro; Mafune, Ryo; Hayashi, Taiyu; Hirata, Yoichiro; Shimizu, Nobuyoshi; Inatomi, Jun; Yokoyama, Yoshiki; Namai, Yoshiyuki; Oda, Y.; Takamizawa, Masaru; Harita, Yutaka; Kawahara, Takuya; Oka, Akira

doi:10.1111/ped.13512

Cited by 11 publications

(17 citation statements)

References 36 publications

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“…The flow chart of the included studies is shown in Figure 1. The characteristics of the 14 enrolled studies involving a total of 70,396 patients are summarized in Table 1 (9,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The outcomes of the eight studies included the effects of early IVIG administration on the occurrence of CAL (17)(18)(19)(20)(21)(26)(27)(28),…”

Section: Search Resultsmentioning

confidence: 99%

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

et al. 2020

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Background: In the latest 2017 American Heart Association guidelines for Kawasaki disease (KD), there are no recommendations regarding the early administration of intravenous immunoglobulin (IVIG). Therefore, the purpose of this systematic review and meta-analysis was to investigate the effects of early IVIG therapy on KD.Methods: We searched databases including the PubMed, Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2019.Results: Fourteen studies involving a total of 70,396 patients were included. Early treatment with IVIG can lead to an increased risk of IVIG unresponsiveness [OR 2.24; 95% CI (1.76, 2.84); P = 0.000]. In contrast to the studies performed in Japan [OR 1.27; 95% CI (0.98, 1.64); P = 0.074] that found no significant difference in coronary artery lesions (CAL) development, studies conducted in China [OR 0.73; 95% CI (0.66, 0.80); P = 0.000] and the United States [OR 0.50; 95% CI (0.38, 0.66); P = 0.000] showed a reduced risk in the occurrence of CAL with early IVIG treatment.Conclusions: At present, the evidence does not support the treatment with IVIG in the early stage of the onset of KD. But, early IVIG treatment could be a protective factor against the development of CAL, which needs to be further clarified.

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Section: Search Resultsmentioning

confidence: 99%

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

et al. 2020

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“…If treated properly, i.e., preferably within the first 10 days of illness with intravenous immunoglobulin (IVIG) and oral aspirin for a prolonged period of time, a decrease in the incidence of CAAs has been reported (3,4). However, with this treatment still ∼2.4-27.8% of the KD patients develop CAAs (5)(6)(7)(8)(9)(10)(11). To further prevent the development of CAAs due to KD, we need more understanding of the etiology of the disease.…”

Section: Introductionmentioning

confidence: 99%

Lower CMV and EBV Exposure in Children With Kawasaki Disease Suggests an Under-Challenged Immune System

et al. 2021

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Background: Kawasaki Disease (KD) is a pediatric vasculitis of which the pathogenesis is unclear. The hypothesis is that genetically pre-disposed children develop KD when they encounter a pathogen which remains most often unidentified or pathogen derived factors. Since age is a dominant factor, prior immune status in children could influence their reactivity and hence the acquisition of KD. We hypothesized that systemic immune responses early in life could protect against developing KD. With this study we tested whether the incidence of previous systemic cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infection is lower in children with KD compared to healthy age-matched controls.Methods and Results: We compared 86 KD patients with an age-matched control group regarding CMV and EBV VCA IgG measurements (taken before or 9 months after IVIG treatment). We found that both CMV and EBV had an almost 2-fold lower seroprevalence in the KD population than in the control group.Conclusions: We suggest that an under-challenged immune system causes an altered immune reactivity which may affect the response to a pathological trigger causing KD in susceptible children.

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“…Propensity score matching is recognized as an effective method for addressing confounding factors related to treatment of the study purpose . Although the randomized control trial is the best method for investigating the effectiveness of a treatment intervention, there are various challenges to conducting them in an emergency department setting.…”

Section: Discussionmentioning

confidence: 99%

“…Propensity score matching is recognized as an effective method for addressing confounding factors related to treatment of the study purpose. 18 Although the randomized control trial is the best method for investigating the effectiveness of a treatment intervention, there are various challenges to conducting them in an emergency department setting. To deal with these issues, applying propensity score matching to the prospective study design can serve as an effective method in emergency medicine research by creating quasi-randomization, provided that the confounding factors in treatment allocation and the predictive factors for the outcomes are appropriately measured.…”

Section: Discussionmentioning

confidence: 99%

Metered‐dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non‐randomized, observational study

Nomura

Ihara

Morikawa

et al. 2020

Pediatrics International

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Background Ipratropium bromide (IB), when administered with β2‐agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered‐dose inhaler (MDI), can, reportedly, shorten patients’ length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI‐delivered IB in pediatric patients with acute asthma exacerbation. Methods This prospective, non‐randomized, observational study included patients aged ≥4 years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20‐min intervals. IB use was determined by the physicians’ treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration. Results Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score‐matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non‐IB group: 31.5%; P = 0.67). The post‐treatment modified pulmonary index scores (mean ± SD) were also similar (IB: 6.6 ± 2.0 vs non‐IB: 6.3 ± 2.5; P = 0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously. Conclusion The metered‐dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation.

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Effect of i.v. immunoglobulin in the first 4 days of illness in Kawasaki disease

Abstract: IVIG treatment by day 4 of illness is associated with the requirement for additional treatment even after adjustment of baseline characteristics. Increased resistance to IVIG when given by day 4 should be considered in order to improve the treatment regimen for early-diagnosed KD.

Cited by 11 publications

References 36 publications

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

Lower CMV and EBV Exposure in Children With Kawasaki Disease Suggests an Under-Challenged Immune System

Metered‐dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non‐randomized, observational study

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