Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase

Abstract

Objectives: Kawasaki disease (KD) is an acute systemic vasculitis that most commonly causes acquired cardiac disease in children in developed countries. The most highly recommended treatment for KD is 2 g/kg intravenous immunoglobulin (IVIG). There are two types of IVIG, sodium-containing (high Na) and sodium-trace (low Na) preparations. However, few studies have compared the effects of these two preparations for superiority. The purpose of this study was to compare outcomes between high and low Na IVIG preparations in KD children using a national inpatient database in Japan.Methods: We used the Diagnostic Procedure Combination database to identify KD patients treated with IVIG between 2010 and 2017. We identi ed those receiving high and low Na preparations of IVIG as an initial treatment. Outcomes included proportion of coronary artery abnormalities (CAA), IVIG resistance, adverse effects, length of stay, and medical cost. Propensity score-matched analyses were conducted to compare the outcomes between the two groups. Instrumental variable analyses were performed to con rm the results.Results: We identi ed 42345 patients with KD. There were signi cant differences in proportions of CAA (2.8% vs. 3.2%; p=0.031) and IVIG resistance (17% vs. 18%; p=0.001) between the two groups. However, there were no signi cant differences in length of stay or medical cost. The instrumental variable analysis con rmed the same results as the propensity score analysis.Conclusions: The present study suggests that high Na IVIG is potentially effective for reducing the proportion of CAA in KD patients. Prospective studies are warranted to con rm the effectiveness observed in this study. What Is Known:For treatments of Kawasaki Disease in acute phase, intravenous immunoglobulin have been the most recommended to reduce fever early and prevent complications of coronary artery abnormalities. There are two types of IVIG preparations, sodium-containing IVIG and sodium-trace IVIG. However, few studies have performed comparisons to determine which preparation of IVIG is superior.What Is New:The present ndings suggest that high-Na IVIG is associated with reductions in the proportions of CAAs and IVIG resistance in KD patients.

A novel model for predicting intravenous immunoglobulin-resistance in Kawasaki disease: a large cohort study

“…Although standard treatments are available for acute-phase KD, the efficacy of different brands or preparations of IVIG for KD has attracted attention. Suzuki et al (29) conducted a study of 42,345 KD children who received IVIG treatment. These authors found that 2.8% patients receiving high Na + concentration IVIG as initial treatment developed CAA compared to 3.2% of those who received low concentrations (p = 0.031).…”

Consensus Committee of experts on Kawasaki Disease and Chinese Journal of Contemporary Pediatrics – the expert consensuses on intravenous immunoglobulin, aspirin, and glucocorticoid

“…[17][18][19] The consensus aims to provide a basis for the standardized clinical management of KD in China, ultimately achieving effective prevention of complications and sequelae in children with KD and reducing the risk of cardiovascular events and death in children with KD. 20,21…”