Intravenous Immunoglobulin Retreatment in Kawasaki Disease: The Comparison between Single 2 g/kg and 1 g/kg

ABSTRACT

PURPOSE: Patients with Kawasaki disease (KD) who remain febrile after first dose of intravenous immunoglobulin (IVIG) are usually treated with a second dose of IVIG. However, the optimal dosage of IVIG in the retreatment of KD is still controversial. We evaluated the impact of IVIG dose difference on the coronary artery lesion (CAL) in the retreatment of KD. METHODS: We performed a prospective study on 24 patients with KD requiring IVIG retreatment from January 2000 to December 2004. The patients were assigned to receive IVIG in the retreatment of KD either as a single infusion of 2 g/kg (A group, 12 patients) or 1 g/kg (B group, 24 patients). We compared the CAL of B group to that of A group for comparable risk of both groups. RESULTS: The incidence of CAL was significantly higher in the 5 of 24 (20.9%) patients with IVIG retreatment vs the 18 of 315 (5.8%) afebrile patients after first course of IVIG treatment (P=0.016). There were no significant differences in age, sex, and other clinical and laboratory findings known as risk factors of CAL between the two groups. Among 24 patients with IVIG retreatment, there were no significant difference in the incidence of CAL between the two groups(Group A, 3/12=25%, vs Group B, 2/12=16.7%) (P>0.05). CONCLUSION: Single 1 g/kg IVIG therapy is comparable outcome to single 2 g/kg IVIG therapy in the retreatment of KD, although the efficacy of this practice requires assessment with a randomized controlled prospective trial in more patients.