Low- versus high-concentration intravenous immunoglobulin for children with Kawasaki disease in the acute phase

Takanori Suzuki, Nobuaki Michihata, Tetsushi Yoshikawa, Kazuyoshi Saito, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Few studies have compared the effects of low-concentration (5%) and high-concentration (10%) intravenous immunoglobulin (IVIG) preparations for patients with Kawasaki disease (KD) in the acute phase. The purpose of this study was to compare outcomes between low- and high-concentration IVIG preparations in children with KD, using a national inpatient database in Japan. Method: We used the Diagnostic Procedure Combination database to identify patients with KD treated with IVIG from April 2012 to March 2020. We identified those receiving high- and low-concentration IVIG preparations as an initial treatment. The outcomes included the proportions of patients with coronary artery abnormalities (CAAs) and IVIG resistance, length of stay, and medical costs. Propensity score-matched analyses were conducted to compare the outcomes between the 2 groups. Instrumental variable analyses were performed to confirm the results. Result: We identified 48 046 patients with KD and created 4:1 propensity score-matched pairs between the low- and high-concentration IVIG groups. There was a significant difference in the percentage with IVIG resistance between the 2 groups (20.6% vs 24.1%; risk difference, 3.5% [95% confidence interval, 2.3-4.7]; P <.001). However, there was no significant difference in CAAs (1.6% vs 1.6%; risk difference, 0.013% [95% confidence interval, −0.34 to 0.37]; P =.953). The instrumental variable analyses showed similar results. Conclusions: The proportion of CAAs did not differ significantly between those receiving low- and high-concentration IVIG. To confirm the results of this study, prospective studies adjusting for duration of IVIG administration and duration of observation are needed.

Original languageEnglish
Pages (from-to)576-583
Number of pages8
JournalInternational Journal of Rheumatic Diseases
Volume25
Issue number5
DOIs
Publication statusPublished - 05-2022

All Science Journal Classification (ASJC) codes

  • Rheumatology

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