Intravenous Immunoglobulin for the Treatment of Kawasaki Disease

Summary

A Cochrane review [Abstract] 1 included 31 studies with a total of 4 609 children with Kawasaki disease (KD). Studies compared intravenous immunoglobulin (IVIG) with acetylsalicylic acid (ASA), another dose or regimen of IVIG, prednisolone, or infliximab. The majority of studies reported on primary treatment, and a limited number of studies investigated secondary or tertiary treatment in IVIG-resistant patients; results for primary treatment are reported here. The total dose and frequency of IVIG treatment varied between studies and ranged from 50 to 100 mg/kg/day to 2 g/kg/day as either a single dose or daily infusions for up to 5 days. The majority of participants received ASA in addition to IVIG.

Compared to ASA, IVIG reduced the incidence of coronary artery abnormalities (CAAs) up to 30 days (OR 0.60, 95% CI 0.41 to 0.87; 11 studies, n=1 437). Duration of fever days was shorter in the IVIG group (MD −4.00 days, 95% CI −5.06 to −2.93; 3 studies, n=307).

Higher-dose regimens of IVIG (2 g/kg) reduced the incidence of CAAs up to 30 days (OR 0.60, 95% CI 0.40 to 0.89; 8 studies, n=1 824), the duration of fever (MD −0.71 days, 95% CI −1.36 to −0.06; 4 studies, n=992), and the need for additional treatment (OR 0.29, 95% CI 0.10 to 0.88; 4 studies, n=1 125) compared to medium- or lower-dose regimens (ranging from 1000 mg/kg to 500 mg/kg).