Comparative Effectiveness of Intravenous Immunoglobulin for Children with Kawasaki Disease: A Nationwide Cohort Study
Resource
PLoS One, 8(5)
Journal
PLoS ONE
Journal Volume
8
Journal Issue
5
Date Issued
2013
Author(s)
Lin, Ming-Chih
Fu, Yun-Ching
Jan, Sheng-Ling
Lai, Mei-Shu
Abstract
Introduction:Different immunoglobulin manufacturing processes may influence its effectiveness for Kawasaki disease. However, nationwide studies with longitudinal follow-up are still lacking. The aim of this study was to evaluate the comparative effectiveness of immunoglobulin preparations from a nationwide perspective.Materials and Methods:This is a nationwide retrospective cohort study with a new user design. Data came from the National Health Insurance Research Database of Taiwan. From 1997 to 2008, children under 2 years old who received immunoglobulin therapy for the first time under the main diagnosis of Kawasaki disease were enrolled. The manufacturing processes were divided into β-propiolactonation, acidification and those containing IgA. The endpoints were immunoglobulin non-responsiveness, acute aneurysm, prolonged use of anti-platelets or anti-coagulants, and recurrence.Results:In total, 3830 children were enrolled. β-propiolactonation had a relative risk of 1.45 (95% CI 1.08?1.94) of immunoglobulin non-responsiveness, however, the relative risks for acidification and containing IgA were non-significant. For acute aneurysms, acidification had a relative risk of 1.49 (95% CI 1.17?1.90), however the relative risks for β-propiolactonation and containing IgA were non-significant. For prolonged use of anti-platelets or anti-coagulants, β-propiolactonation had a relative risk of 1.44 (95% CI 1.18?1.76), and acidification protected against them both with a relative risk of 0.82 (95% CI 0.69?0.97), whereas the relative risk for containing IgA was non-significant. For recurrence, all three factors were non-significant.Conclusions:The effectiveness of immunoglobulin may differ among different manufacturing processes. β-propiolactonation had a higher risk of treatment failure and prolonged use of anti-platelets or anti-coagulants. Acidification may increase the risk of acute coronary aneurysms. ? 2013 Lin et al.
SDGs
Other Subjects
anticoagulant agent; antithrombocytic agent; immunoglobulin; immunoglobulin A; immunoglobulin G; immunoglobulin; acidification; article; child; cohort analysis; comparative effectiveness; controlled study; coronary artery aneurysm; drug efficacy; drug response; drug treatment failure; female; human; immunotherapy; long term care; major clinical study; male; mucocutaneous lymph node syndrome; preschool child; recurrence risk; retrospective study; comparative study; disease free survival; drug formulation; infant; Kaplan Meier method; mucocutaneous lymph node syndrome; risk; sensitivity and specificity; treatment failure; Disease-Free Survival; Drug Compounding; Female; Humans; Immunoglobulins, Intravenous; Infant; Kaplan-Meier Estimate; Male; Mucocutaneous Lymph Node Syndrome; Odds Ratio; Retrospective Studies; Sensitivity and Specificity; Treatment Failure
Type
journal article
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