Objectives: A high-dose (2g/kg) intravenous immunoglobulin (IVIG) has been generally incorporated into the acute treatment protocols for Kawasaki disease (KD), with ongoing debates on this issue. The aim of this study was to assess the effectiveness of medium-dose (1g/kg) IVIG as an initial treatment of KD in Korean children.
Methods: A retrospective study was done in a total of 255 children with KD, in whom 91 patients (group 1, mean age; 2.8 ± 2.5 years) had 2g/kg of IVIG and 164 patients (group 2, mean age; 2.7 ± 1.7 years) had 1g/kg of IVIG as an initial treatment of KD, along with 30-50 mg/kg of aspirin. Echocardiography (Echo) was done during admission, around 2 weeks, 2 months, and 1 year after the onset of fever according to our protocol. Patients who completed one-year Echo study were included in this study. Patients’ demographic, laboratory, and Echo findings were recorded, and compared between groups. Coronary artery lesions (CAL) were defined as a coronary artery diameter > 2 SD of normal mean for age or coronary artery stenosis. The primary end point was the incidence of CAL at 1 year after treatment. The secondary end points were the incidence of CAL at 2 weeks and 2 months study, and clinical outcomes. Comparisons between groups were done using an unpaired t-test or Fisher’s exact test.
Results: There was no significant difference in age, gender, and laboratory findings before treatment between the two groups. Group 1 had higher incidence of CAL at 2 weeks (32/91, 35.2 % vs. 33/164, 20.2 %, p = 0.011), but similar incidence of CAL at 2 months (18/91, 19.8% vs. 24/164, 14.6%, p > 0.05) and 1 year (6/91, 6.6% vs. 10/164, 6.1%, p > 0.05) compared with group 2. Group 1 had a higher proportion of patients needed additional dose of IVIG (23/91, 25.3% vs. 15/164, 9.1%, p = 0.001), but received significantly lower total dose of IVIG (1.3 ± 0.7 g/kg vs. 2.1 ± 0.5 g/kg, p < 0.001) compared with group 2. There was no difference in duration of fever after IVIG and duration of hospital stay between the two groups.
Conclusion: This study demonstrated that medium-dose IVIG is as effective as high-dose IVIG for the treatment of KD in terms of CAL prevention, defervescence, and duration of hospital stay. Further prospective and randomized study is needed to verify this.