Gamma Globulin Therapy in Kawasaki Disease

Abstract

The objectives of this study were to evaluate the therapy protocol of gamma globulin (GG) re-treatment without steroids. Patients. From Jun. 1994 to Jun. 2001, 220 typical patients were enrolled within 8 days of illness. They had no coronary artery dilatation at admission and before GG treatment. Their risks were evaluated by the Iwasa's risk score system. Of 220 patients, 66% were selected as high-risk patients and 80% were treated with GG. Initial dose of GG was single 2g/kg for the high-risk patients and 1g/kg for the low-risk patients with prolonged fever, 49 patients had GG re-treatment. Maximum dose of GG was 8g/kg and mean dose of GG was 1.8g/kg per patient. Dose of re-treatment after Sep. 1996 was decided by WBC and CRP before and after GG treatment. Results. Of 220 patients, 13 patients had coronary artery lesions (CAL, over 3 mm in diameter) in acute stage and 3 patients had CAL at 30th days of illness, which were all transient dilatation. In high-risk female patients, 51 patients treated with GG had no CAL. In high-risk male patients from Jun. 1994 to Jun. 1999, 60 patients were treated with sulfonated GG (Sulfo-GG) or GG prepared by propylene glycol (PEG-GG). And CAL (8/31) in Sulfo-GG group was significantly higher than CAL (1/29) in PEG-GG group (p=0.017). In high-risk male patients after Jul. 1999, when we did not use Sulfo-GG, 1/22 had CAL. The other 3 CAL patients, whose CAL were under 3.1 mm in diameter, were high-risk patient without GG, low -risk patient without GG and high-risk patient with GG. Persistent fever over 10 days of illness occurred in 20/159 patients before Jun. 1999, but 3/61 after Jul. 1999. Duration of fever after Jul. 1999 was significantly shorter than that before Jun. 1999 (p = 0.039). Repetition of PEG-GG treatment can reduce CAL.