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Selective high dose gamma‐globulin treatment in Kawasaki disease: Assessment of clinical aspects and cost effectiveness
Author(s) -
Sato NOBORU,
Sugimura TETSU,
Akagi TEIJI,
Yamakawa RUMI,
Hashino KANOKO,
Eto GENJU,
Iemura MOTOFUMI,
Ishii MASAHIRO,
Kato HIROHISA
Publication year - 1999
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1046/j.1442-200x.1999.01014.x
Subject(s) - medicine , kawasaki disease , gamma globulin , artery , aspirin , incidence (geometry) , gastroenterology , coronary artery disease , surgery , immunology , antibody , physics , optics
AbstractBackground : High‐dose intravenous gamma‐globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However, gamma‐globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma‐globulin remain controversial. Objectives : To examine these two issues, we used Harada’s scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. Methods : We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non‐IVGG group) treatment (58 patients). Results : The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C‐reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non‐IVGG group. Conclusions : It was found to be clinically more effective and more cost effective to select a patient by Harada’s scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma‐globulin for acute KD.