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Efficacy and safety associated with the infusion speed of intravenous immunoglobulin for the treatment of Kawasaki disease: a randomized controlled trial

Authors
  • Fukui, Saori1, 2
  • Seki, Mitsuru1
  • Minami, Takaomi1
  • Kotani, Kazuhiko3
  • Oka, Kensuke1
  • Yokomizo, Akiko1
  • Matsubara, Daisuke1
  • Sato, Tomoyuki1
  • Nozaki, Yasuyuki2
  • Saito, Mari4
  • Kikuchi, Yutaka4
  • Miyamoto, Kenji5
  • Monden, Yukifumi1, 6
  • Yamagata, Takanori1
  • 1 Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan , Tochigi (Japan)
  • 2 Shin-Oyama City Hospital, Tochigi, Japan , Tochigi (Japan)
  • 3 Jichi Medical University, Tochigi, Japan , Tochigi (Japan)
  • 4 Haga Red-Cross Hospital, Tochigi, Japan , Tochigi (Japan)
  • 5 Dokkyo Medical University, Tochigi, Japan , Tochigi (Japan)
  • 6 International University of Health and Welfare Hospital, Tochigi, Japan , Tochigi (Japan)
Type
Published Article
Journal
Pediatric Rheumatology
Publisher
Springer Science and Business Media LLC
Publication Date
Jul 03, 2021
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12969-021-00601-6
Source
Springer Nature
Keywords
Disciplines
  • Research Article
License
Green

Abstract

BackgroundHigh-dose intravenous immunoglobulin (IVIG) is the mainstay of treatment for Kawasaki disease (KD). Usually, 2 g/kg of IVIG is administered over 10–24 h, depending on the institution or physician, but the association between infusion speed and effectiveness has not been reported. In this study, we evaluated the differences in efficacy and safety between two different IVIG administration speeds.MethodsThis was a multicenter, unblinded, randomized controlled study. Patients newly diagnosed with KD were randomized into two groups: one who received IVIG over 12 h (12H group, double speed), and one that received IVIG over 24 h (24H group, reference speed). The endpoints included the duration of fever, incidence of coronary artery abnormalities (CAAs) and of adverse events. Laboratory data were evaluated before and after IVIG administration.ResultsA total of 39 patients were enrolled. There was no difference between groups in fever duration after the initiation of IVIG (21 h vs. 21.5 h, p = 0.325), and no patient experienced CAAs. Two adverse events were observed in the 12H group (elevation of aspartate aminotransferase and vomiting), however no severe adverse events requiring treatments or extension of hospital stay were observed in either group. After initial IVIG administration, the change ratio of inflammatory markers, such as white blood cell counts, neutrophils, C-reactive protein, and albumin, did not show significant differences between the two groups. On the other hand, a greater increase of serum immunoglobulin G from its baseline level was observed in the 24H group compared to the 12H group (3037 ± 648 mg/dl vs. 2414 ± 248 mg/dl, p < 0.01).ConclusionThe efficacy and safety of IVIG administered over 12 h (double speed) were similar to those administered over 24 h (reference speed).Trial registrationUniversity Hospital Medical Information Network (UMIN000014665). Registered 27 July 2014 – Prospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000017058

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