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Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.

ABSTRACT: INTRODUCTION: Different immunoglobulin manufacturing processes may influence its effectiveness for Kawasaki disease. However, nationwide studies with longitudinal follow-up are still lacking. The aim of this study was to evaluate the comparative effectiveness of immunoglobulin preparations from a nationwide perspective. MATERIALS AND METHODS: This is a nationwide retrospective cohort study with a new user design. Data came from the National Health Insurance Research Database of Taiwan. From 1997 to 2008, children under 2 years old who received immunoglobulin therapy for the first time under the main diagnosis of Kawasaki disease were enrolled. The manufacturing processes were divided into ?-propiolactonation, acidification and those containing IgA. The endpoints were immunoglobulin non-responsiveness, acute aneurysm, prolonged use of anti-platelets or anti-coagulants, and recurrence. RESULTS: In total, 3830 children were enrolled. ?-propiolactonation had a relative risk of 1.45 (95% CI 1.08~1.94) of immunoglobulin non-responsiveness, however, the relative risks for acidification and containing IgA were non-significant. For acute aneurysms, acidification had a relative risk of 1.49 (95% CI 1.17~1.90), however the relative risks for ?-propiolactonation and containing IgA were non-significant. For prolonged use of anti-platelets or anti-coagulants, ?-propiolactonation had a relative risk of 1.44 (95% CI 1.18~1.76), and acidification protected against them both with a relative risk of 0.82 (95% CI 0.69~0.97), whereas the relative risk for containing IgA was non-significant. For recurrence, all three factors were non-significant. CONCLUSIONS: The effectiveness of immunoglobulin may differ among different manufacturing processes. ?-propiolactonation had a higher risk of treatment failure and prolonged use of anti-platelets or anti-coagulants. Acidification may increase the risk of acute coronary aneurysms.

SUBMITTER: Lin MC

PROVIDER: S-EPMC3641142 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.

Lin Ming-Chih MC Fu Yun-Ching YC Jan Sheng-Ling SL Lai Mei-Shu MS

PloS one 20130501 5

<h4>Introduction</h4>Different immunoglobulin manufacturing processes may influence its effectiveness for Kawasaki disease. However, nationwide studies with longitudinal follow-up are still lacking. The aim of this study was to evaluate the comparative effectiveness of immunoglobulin preparations from a nationwide perspective.<h4>Materials and methods</h4>This is a nationwide retrospective cohort study with a new user design. Data came from the National Health Insurance Research Database of Taiw ...[more]

PMID: 23650564

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Project description:The purpose of this study was to identify the clinical features and laboratory factors that are predictive of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. Multiple databases were searched for relevant studies on IVIG-resistant Kawasaki disease published from January 2002 to April 2017. Eligible studies were retrieved by manual review of the references. Stata 12 was used for the meta-analysis. Weighted mean differences and odds ratios with 95% confidence intervals were calculated for several indices. Twenty-eight studies involving 26,260 patients comprising 4442 IVIG-resistant Kawasaki disease patients and 21,818 IVIG-sensitive Kawasaki disease patients were included. The meta-analysis showed that the erythrocyte sedimentation rate (ESR) in the IVIG-resistant group was significantly higher than that in the IVIG-sensitive group, and that platelet count and hemoglobin levels were significantly lower in the IVIG-resistant group. The patients with oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, polymorphous rash, and initial administration of IVIG ??4.0 days after the onset of symptoms were more likely to be IVIG resistant.ConclusionThe initial administration of IVIG ??4.0 days after the onset of symptoms increased ESR and decreased hemoglobin and platelet counts, oral mucosa alterations, cervical lymphadenopathy, swelling of the extremities, and polymorphous rash and are the risk factors for IVIG-resistant Kawasaki disease. What is Known: • Recent reports on this topic are about aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyl transferase, total bilirubin, white blood cells, platelets, erythrocyte sedimentation rate (ESR), polymorphonuclear leukocytes (PMN), C-reactive protein (CRP), pro-brain natriuretic peptide (BNP), albumin, and sodium as the risk factors in the IVIG-resistant Kawasaki disease; however, no studies have been published on clinical features as predictors of IVIG resistance. What is New: • This meta-analysis identified the clinical features, the initial administration of IVIG?? 4.0 days after the onset of symptoms, and much more comprehensive laboratory indicators, such as hemoglobin, as predictors of IVIG-resistant Kawasaki disease.

Dataset Information

Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.

Publications

Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.

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