Intravenous immunoglobulin preparation type: association with outcomes for patients with acute Kawasaki disease.

Abstract

To determine whether two different intravenous immunoglobulin (IVIG) preparations were equally efficacious in the treatment of Kawasaki disease (KD). Single centre retrospective review of all patients treated with IVIG for KD between January 1990 and April 2007. Comparison of IVIG (dose 2 g/kg) from two commercial preparations; Iveegam stabilized with sugar (lyophilized, 5 g/ml glucose, pH 6.4-7.2, IgA 10 microg/ml, 5% IgG/ml) and Gamimune stabilized through acidification (no sugar, pH 4.0-4.5, IgA 270 microg/ml, 5% 1990-1999, 10% 1999-2007 IgG/ml). Propensity-adjusted differences in duration of fever after treatment initiation, frequency of retreatment with IVIG, hospital stay and maximum coronary artery z-score. A total of 954 patients were included, 862 (90%) were treated with Iveegam and 92 (10%) were treated with Gamimune. Patients' demographic, clinical and laboratory characteristics were similar between the two groups. In propensity-adjusted models, Iveegam was found to be associated with higher probability of non-response to IVIG (12% vs. 5%, p = 0.05) and longer median duration of fever after IVIG [1 (1-27) vs. 1 (1-8) days, p = 0.02] than Gamimune. Nevertheless, Gamimune was found to be associated with longer median duration of hospital stay [5 (2-49) vs. 4 (2-76) days, p < 0.0001] and higher median maximum coronary artery z-score both at the end of the acute phase (+1.4 vs. +0.8, p < 0.0001) and 6-8 weeks after the acute phase (+0.7 vs. +0.4, p < 0.0001). IVIG preparations with lower IgA content and stabilized with glucose appear to be associated with improved coronary artery outcomes for patients with KD.

• Authors: Cedric Manlhiot, Rae S M Yeung, Nita Chahal, Brian W McCrindle
• Journal: Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (Pediatr Allergy Immunol) Vol. 21 Issue 3 Pg. 515-21 (May 2010) ISSN: 1399-3038 [Electronic] England
• PMID: 20546528 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Immunoglobulins, Intravenous
• Immunologic Factors
• Glucose

Topics

• Acute Disease
• Adolescent
• Child
• Child, Preschool
• Coronary Artery Disease (complications, drug therapy, epidemiology)
• Drug Compounding (methods)
• Female
• Fever (complications, drug therapy)
• Glucose (chemistry)
• Humans
• Hydrogen-Ion Concentration
• Immunoglobulins, Intravenous (administration & dosage, chemistry, therapeutic use)
• Immunologic Factors (therapeutic use)
• Infant
• Length of Stay
• Male
• Mucocutaneous Lymph Node Syndrome (complications, drug therapy, epidemiology)
• Treatment Outcome