N. Sato et al., Selective high dose gamma-globulin treatment in Kawasaki disease: Assessment of clinical aspects and cost effectiveness, PEDIATR INT, 41(1), 1999, pp. 1-7
Background: 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, especial
ly 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 th
e 5 day 400 mg/kg per day therapy.
Methods: We studied 203 patients with KD who had no coronary artery complic
ations on admission. Of these, 145 patients scored 4 or more on Harada scor
e 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 H
arada score of three or less received no IVGG (non-IVGG group) treatment (5
8 patients).
Results: The incidence rate of coronary artery complications in the 2 g gro
up was significantly lower than in the 400 mg group. The duration of high f
ever, positive duration of C-reactive protein and the number of hospital da
ys in the 2 g group were each significantly shorter than in the 400 mg grou
p. 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 eff
ective 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.