A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute kawasaki syndrome

Jane W. Newburger*, Steven D. Colan, Robert P. Sundel, Alexa S. Beiser, Fred S. Rosen, C. Elise Duffy, Anne H. Rowley, Stanford T. Shulman, Mary P. Glode, James W. Wiggins, Wilbert H. Mason, Masato Takahashi, Jane C. Burns, John Bastian, Kyung Ja Chung, David R. Fulton, H. Cody Meissner, Marian E. Melish, Venudhar Reddy, Theodore Colton

*Corresponding author for this work

Research output: Contribution to journalArticle

891 Scopus citations

Abstract

Treatment of acute Kawasaki syndrome with a four-day course of intravenous gamma globulin, together with aspirin, has been demonstrated to be safe and effective in preventing coronary-artery lesions and reducing systemic inflammation. We hypothesized that therapy with a single, very high dose of gamma globulin would be at least as effective as the standard regimen. We conducted a multicenter, randomized, controlled trial involving 549 children with acute Kawasaki syndrome. The children were assigned to receive gamma globulin either as a single infusion of 2 g per kilogram of body weight over 10 hours or as daily infusions of 400 mg per kilogram for four consecutive days. Both treatment groups received aspirin (100 mg per kilogram per day through the 14th day of illness, then 3 to 5 mg per kilogram per day). The relative prevalence of coronary abnormalities, adjusted for age and sex, among patients treated with the four-day regimen, as compared with those treated with the single-infusion regimen, was 1.94 (95 percent confidence limits, 1.01 and 3.71) two weeks after enrollment and 1.84 (95 percent confidence limits, 0.89 and 3.82) seven weeks after enrollment. Children treated with the single-infusion regimen had lower mean temperatures while hospitalized (day 2, P<0.001; day 3, P = 0.004), as well as a shorter mean duration of fever (P = 0.028). Furthermore, in the single-infusion group the laboratory indexes of acute inflammation moved more rapidly toward normal, including the adjusted serum albumin level (P = 0.004), alpha1-antitrypsin level (P = 0.007), and C-reactive protein level (P = 0.017). Lower IgG levels on day 4 were associated with a higher prevalence of coronary lesions (P = 0.005) and with a greater degree of systemic inflammation. The two groups had a similar incidence of adverse effects (including new or worsening congestive heart failure in nine children), which occurred in 2.7 percent of the children overall. All the adverse effects were transient. 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. (N Engl J Med 1991; 324: 1633–9.)

Original languageEnglish (US)
Pages (from-to)1633-1639
Number of pages7
JournalNew England Journal of Medicine
Volume324
Issue number23
DOIs
StatePublished - Jun 6 1991

ASJC Scopus subject areas

  • Medicine(all)

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    Newburger, J. W., Colan, S. D., Sundel, R. P., Beiser, A. S., Rosen, F. S., Duffy, C. E., Rowley, A. H., Shulman, S. T., Glode, M. P., Wiggins, J. W., Mason, W. H., Takahashi, M., Burns, J. C., Bastian, J., Chung, K. J., Fulton, D. R., Meissner, H. C., Melish, M. E., Reddy, V., & Colton, T. (1991). A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute kawasaki syndrome. New England Journal of Medicine, 324(23), 1633-1639. https://doi.org/10.1056/NEJM199106063242305