Clinical Responses of Patients with Kawasaki Disease to Different Brands of Intravenous Immunoglobulin

Abstract

Objective To determine whether different brands of intravenous immunoglobulin (IVIG) administered to children with Kawasaki disease (KD) result in different outcomes. Study design We analyzed children with KD and divided them into 4 groups according to the brand of IVIG. A coronary artery abnormality (CAA) was defined as having a lumen diameter (inner border to inner border) of ≥3 mm in KD cases <5 years old and ≥ ;4 mm in cases ≥5 years old, and giant aneurysm was defined as a lumen diameter 8 mm. Patients were considered nonresponsive to IVIG therapy if fever persisted longer than 2 days after completion of treatment and needed retreatment with IVIG. Results We collected 437 cases , 29 (6.6%) were nonresponsive , 17 (3.9%) had CAA at convalescence, and 3 (0.7%) had giant aneurysm, 2 of whom had development of myocardial infarcts. Patients receiving Brand C IVIG, prepared with β- propiolactone , had higher rates (10%, 9/93, P = .01) of CAA at convalescence and nonresponsiveness (13%, 12/93, P = .001 ); giant aneurysm occurred in 3/93 (3%) receiving Brand C IVIG and in 0/344 who received the other 3 brands (P = .008) . Conclusions IVIG, prepared with β-propiolactone, was most significantly associated with nonresponsiveness, CAA at convalescence, and giant aneurysm. Physicians should be cautious when using IVIG prepared with β-propiolactone or enzyme digestion to treat KD.