Meta-analysis of the results of intravenous gamma globulin treatment of coronary artery lesions in Kawasaki disease

Mori, Masaaki; Miyamae, Takako; Imagawa, Tomoyuki; Katakura, Shigeki; Kimura, Kazuhiro; Yokota, Shumpei

doi:10.1007/s10165-004-0324-3

Cited by 17 publications

(9 citation statements)

References 15 publications

(32 reference statements)

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“…The mainstay of initial treatment for both complete and incomplete KD is a single high dose of IVIG together with acetylsalicylic acid (ASA), which is supported by clinical trial evidence. 127,157 This section covers treatment from onset of the acute illness until resolution of acute systemic inflammation and when coronary artery luminal dimensions have stabilized and are no longer expanding.…”

Section: Treatment Of the Acute Illness Initial Treatment Of Kdmentioning

confidence: 99%

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Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,757

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Treatment Of the Acute Illness Initial Treatment Of Kdmentioning

confidence: 99%

“…126,158,159 Meta-analyses of IVIG compared with placebo have shown a conclusive decrease in new coronary artery abnormalities among IVIG-treated patients. 157,160 The mechanism of action of IVIG in treatment of KD is unknown. IVIG appears to have a generalized anti-inflammatory effect.…”

Section: Intravenous Immunoglobulinmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,757

4,124

View full text Add to dashboard Cite

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“…Even with prompt IVIG therapy, up to 20% of children will develop recurrent or persistent fevers. These children are termed IVIG-resistant [61][62][63]. There are several risk factors for IVIG-resistant KD including delayed initial IVIG administration, increased ESR, decreased hemoglobin and platelet levels, oral mucosal alterations, cervical lymphadenopathy, extremity swelling, and polymorphous rash [64•].…”

Section: Primary Treatmentmentioning

confidence: 99%

Kawasaki Disease: an Update

2020

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Purpose of Review Provide the most recent updates on the epidemiology, pathogenesis, and treatment advances in Kawasaki disease. Recent Findings Treatment advances in complex, IVIG-refractory cases of Kawasaki disease. Multisystem inflammatory syndrome, a newly reported inflammatory condition with Kawasaki-like features and an association with the 2019 Coronavirus (COVID-19). Summary Kawasaki disease (KD) is a rare systemic inflammatory disease that predominately affects children less than 5 years of age. Pathogenesis of KD remains unknown; the leading theory is that an unknown stimulus triggers an immune-mediated inflammatory cascade in a genetically susceptible child. Classic KD is a clinical diagnosis based on set criteria and excluding other similar clinical entities. Patients who do not fulfill complete diagnostic criteria for KD are often referred to as atypical (or incomplete) KD. The most feared complication of KD is coronary artery abnormality development, and patients with atypical KD are also at risk. Administration of intravenous immunoglobulin (IVIG) and aspirin has greatly reduced the incidence of coronary lesions in affected children. Several other immune-modulating therapies have recently been utilized in complex or refractory cases. Keywords Kawasaki disease. Kawasaki review. Kawasaki treatment. Kawasaki workup. Kawasaki differential. Kawasaki diagnosis. Multi system inflammatory syndrome. Kawasaki-like disease Pathogenesis Genetics Although poorly understood, the predilection for children of East Asian and Pacific Islander descent, even with transmigration, This article is part of the Topical Collection on Vasculitis * Eileen Rife

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“…When compared with the CAL incidence of 5% in treated patients, our result had a lower incidence, though the difference was not statistically significant. In a meta-analysis of IVIG results, the incidence of CALs was 10.8% at 30 days and 2.8% at 60 days after the onset of treatment 17). Compared with these previous studies, IVIG-SN was not inferior.…”

Section: Discussionmentioning

confidence: 66%

Multicenter, Single-Arm, Phase IV Study of Combined Aspirin and High-Dose “IVIG-SN” Therapy for Pediatric Patients with Kawasaki Disease

Yoon

Lee

et al. 2017

Korean Circ J

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Background and ObjectivesIntravenous immunoglobulin-SN (IVIG-SN) is a new human immunoglobulin product. Its safety is ensured by pathogen-elimination steps comprising solvent/detergent treatment and a nanofiltration process. This multicenter clinical study was designed to evaluate the efficacy and safety of combined aspirin and high-dose IVIG-SN therapy in pediatric patients with Kawasaki disease (KD).Subjects and MethodsWe evaluated coronary artery lesions (CALs) at 2 and 7 weeks after administering IVIG-SN; total fever duration; and variations in erythrocyte sedimentation rate, N-terminal pro B-type natriuretic peptide or B-type natriuretic peptide, and creatine kinase-myocardial band level before and after treatment with IVIG-SN (2 g/kg). Adverse events were monitored.ResultsForty-five patients were enrolled, three of whom were excluded according to the exclusion criteria; the other 42 completed the study. The male:female ratio was 0.91:1, and the mean age was 29.11±17.23 months. The mean fever duration before IVIG-SN treatment was 6.45±1.30 days. Although most patients had complete KD (40 patients, 90.91%), four had atypical KD (9.09%). After IVIG-SN treatment, one patient (2.38%) had CALs, which was significantly lower than the incidence reported previously (15%) (p=0.022), but not significantly different from recent data (5%). There were no serious adverse events, though 28 patients (63.64%) had mild adverse events. Three adverse drug reactions occurred in 2 patients (eczema, anemia, and increased eosinophil count), all of which were transient.ConclusionIVIG-SN treatment in patients with KD was safe and effective.

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Meta-analysis of the results of intravenous gamma globulin treatment of coronary artery lesions in Kawasaki disease

Cited by 17 publications

References 15 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Kawasaki Disease: an Update

Multicenter, Single-Arm, Phase IV Study of Combined Aspirin and High-Dose “IVIG-SN” Therapy for Pediatric Patients with Kawasaki Disease

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