High-dose intravenous gamma-globulin therapy in Kawasaki disease

Abstract

The efficacy for reduction of coronary aneurysm in Kawasaki disease was studied from 1984 to 1988 in Taiwan. One hundred and six children with Kawasaki disease were treated by one of the following regimens: regimen I: aspirin and 130-200 mg/kg/day of intravenous gamma-globulin (group I = 7), regimen II: 201-400 mg/kg/day of intravenous gamma-globulin with aspirin (group II = 49) and regimen III: aspirin alone (group III = 43) and no treatment (group IV = 7). By using two-dimensional echocardiography and aortography, the coronary arterial aneurysms noted in group I, II, III and IV were 42.9%, 49.0%, 44.2% and 16.7% respectively within 4 weeks of the illness and were 28.6%, 18.4%, 16.4% and 16.7% respectively during the follow-up period of 11.4 +/- 8.2 months. The incidence of coronary aneurysm was reduced significantly (p less than 0.005) in patients with high-dose gamma-globulin therapy and with aspirin therapy alone. However, there was no difference between group II and III, probably due to delays in the time of start of prophylactic gamma-globulin therapy. There was also significant lower incidence of the giant coronary aneurysm in children with high dose gamma-globulin therapy and with aspirin therapy. (p less than 0.05) The incidences of giant aneurysm in groups I, II, III and IV were 28.6%, 2.0%, 4.7% and 14.3% respectively. These results suggest that even with delay in the time of start of prophylactic gamma-globulin therapy, it still can reduce the formation of giant coronary aneurysm.