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Low‐ versus high‐concentration intravenous immunoglobulin for children with Kawasaki disease in the acute phase
Author(s) -
Suzuki Takanori,
Michihata Nobuaki,
Yoshikawa Tetsushi,
Saito Kazuyoshi,
Matsui Hiroki,
Fushimi Kiyohide,
Yasunaga Hideo
Publication year - 2022
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.14309
Subject(s) - medicine , kawasaki disease , confidence interval , propensity score matching , antibody , significant difference , gastroenterology , artery , immunology
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.