Effectiveness of Medium-Dose Intravenous Immunoglobulin (1 g/kg) in the Treatment of Kawasaki Disease

BACKGROUND AND OBJECTIVES High-dose intravenous immunoglobulin (IVIG) (2 g/kg) is usually given in the treatment of Kawasaki disease (KD). According to the authors' experience, however, medium-dose immunoglobulin (1 g/kg) was also effective in the majority of patients. We performed a retrospective clinical study to validate effectiveness of the medium-dose regimen in treatment of KD. SUBJECTS AND METHODS A total of 274 patients with KD who were treated with medium-dose immunoglobulin at Bundang Jesaeng General Hospital from July 1998 to October 2007 were enrolled. RESULTS Medium-dose immunoglobulin was given once in 220 patients (group A; 80.3%) and twice or more in 54 patients (group B; 19.7%). Age and gender distributions, duration of fever before treatment, hemoglobin concentrations, and white blood cell and platelet counts did not differ significantly between the two groups (p>0.05). Concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase, and bilirubin were significantly higher in group B (p<0.005). Coronary arterial lesions (CAL) were found in 51 patients (23.2%) in group A and in 26 patients (48.1%) in group B during the acute stage, and in 14 patients (6.4%) in group A and in 11 patients (20.4%) in group B during the convalescent stage (p<0.005, respectively). A giant aneurysm was found in one patient in each group (0.5% in group A and 1.9% in group B; p<0.005) during the follow-up period. CONCLUSION A single infusion of medium-dose immunoglobulin was effective in 80% of patients with KD. About 20% of patients required two or more infusions of medium-dose immunoglobulin, who had higher concentrations of C-reactive protein, aspartate aminotransferase, alanine aminotransferase and bilirubin. The authors think that the medium-dose regimen proffers an advantage over the high-dose regimen in view of cost-effectiveness.