Intravenous immunoglobulin for the treatment of Kawasaki disease in children
Richmal Marie Oates‐Whitehead,J Harry Baumer,Linda Haines,Samantha Love,Ian Maconochie,Amit Gupta,Kevin S. Roman,Jaspal Dua,Ichiko Flynn +8 more
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TLDR
Evaluated randomised controlled trials of intravenous immunoglobulin to treat Kawasaki disease in children showed a significant decrease in new coronary artery abnormalities (CAAs) in favour of IVIG, and children fulfilling the diagnostic criteria for Kaw Osaka disease should be treated with IVIG within 10 days of onset of symptoms.Abstract:
Background Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. The coronary arteries supplying the heart can be damaged in Kawasaki disease. The principal advantage of timely diagnosis is the potential to prevent this complication with early treatment. Intravenous immunoglobulin (IVIG) is widely used for this purpose. Objectives The objective of this review was to evaluate the effectiveness of IVIG in treating, and preventing cardiac consequences, of Kawasaki disease in children. Search strategy Electronic searches of the Cochrane Peripheral Vascular Disease Group Specialised Register, CENTRAL, MEDLINE, EMBASE, and CINAHL were performed (last searched April 2003). We also searched references from relevant articles and contacted authors where necessary. In addition we contacted experts in the field for unpublished works. Selection criteria Randomised controlled trials of intravenous immunoglobulin to treat Kawasaki disease were eligible for inclusion. Data collection and analysis Fifty-nine trials were identified in the initial search. On careful inspection only sixteen of these met all the inclusion criteria. Trials were data extracted and assessed for quality by at least two reviewers. Data were combined for meta-analysis using relative risk ratios for dichotomous data or weighted mean difference for continuous data. A random effects statistical model was used. Main results The meta-analysis of IVIG versus placebo, including all children, showed a significant decrease in new coronary artery abnormalities (CAAs) in favour of IVIG, at thirty days RR (95% CI) = 0.74 (0.61 to 0.90). No statistically significant difference was found thereafter. A subgroup analysis excluding children with CAAs at enrollment also found a significant reduction of new CAAs in children receiving IVIG RR (95%) = 0.67 (0.46 to 1.00). There was a trend towards benefit from IVIG at sixty days (p=0.06). Results of dose comparisons showed a decrease in the number of new CAAs with increased dose. The meta-analysis of 400 mg/kg/day for five days versus 2 gm/kg in a single dose showed statistically significant reduction in CAAs at thirty days RR (95%) = 4.47 (1.55 to 12.86). This comparison also showed a significant reduction in duration of fever with the higher dose. There was no statistically significant difference noted between different preparations of IVIG. There was no statistically significant difference of adverse effects in any group. Reviewer's conclusions Children fulfilling the diagnostic criteria for Kawasaki disease should be treated with IVIG (2 gm/kg single dose) within 10 days of onset of symptoms.read more
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Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.
Brian W. McCrindle,Anne H. Rowley,Jane W. Newburger,Jane C. Burns,Anne F. Bolger,Michael H. Gewitz,Annette L. Baker,Mary Anne Jackson,Masato Takahashi,Pinak B. Shah,Tohru Kobayashi,Mei-Hwan Wu,Tsutomu Saji,Elfriede Pahl +13 more
TL;DR: These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
Journal ArticleDOI
Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology
Jordan S. Orange,Elham Hossny,Catherine R. Weiler,Mark Ballow,Melvin Berger,Francisco A. Bonilla,Rebecca H. Buckley,Javier Chinen,Yehia El-Gamal,Bruce Mazer,Robert P. Nelson,Dhavalkumar D. Patel,Elizabeth Secord,Ricardo U. Sorensen,Richard L. Wasserman,Charlotte Cunningham-Rundles +15 more
TL;DR: In this review, the evidence underlying a wide variety of IGIV uses is evaluated and specific recommendations on the basis of these data are made.
Journal ArticleDOI
Update on the use of immunoglobulin in human disease: A review of evidence
Elena E. Perez,Jordan S. Orange,Francisco A. Bonilla,Javier Chinen,Ivan K. Chinn,Morna J. Dorsey,Yehia El-Gamal,Terry Harville,Elham Hossny,Bruce Mazer,Robert P. Nelson,Elizabeth Secord,Stanley C. Jordan,E. Richard Stiehm,Ashley Vo,Mark Ballow +15 more
TL;DR: This work provides an update of the evidence‐based guideline on immunoglobulin therapy, last published in 2006, and suggests that careful consideration of its indications and administration is warranted.
Journal ArticleDOI
Clinical uses of intravenous immunoglobulin
TL;DR: It will be important to increase the evidence base for IVIG in many conditions to define its therapeutic role, and future studies will need to address questions of efficacy, pharmacoeconomics, dose, adjunctive therapies and mechanism of action.
Journal ArticleDOI
Failure of intravenous immunoglobulin to prevent congenital heart block: Findings of a multicenter, prospective, observational study.
Cecilia N. Pisoni,Antonio Brucato,A. Ruffatti,Gerard Espinosa,Ricard Cervera,M. Belmonte-Serrano,Julio Sánchez-Román,F. G. Garcia-Hernandez,Angela Tincani,Maria Tiziana Bertero,Andrea Doria,Grv Hughes,Munther A. Khamashta +12 more
TL;DR: IVIG at the dose and frequency used in this study was not effective as prophylactic therapy for CHB in high-risk mothers.
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TL;DR: In children with acute Kawasaki disease, a single large dose of intravenous gamma globulin is more effective than the conventional regimen of four smaller daily doses and is equally safe.