NEW YORK (Reuters Health) – Intravenous immunoglobulin therapy started 10 days or more after onset of Kawasaki disease (KD) suppresses inflammation but does not prevent coronary artery lesions, a Japanese team reports in Pediatrics online January 16.

“Physicians should therefore treat such patients with IVIG as soon as possible when a diagnosis of KD is strongly suspected,” conclude Dr. Hiromi Muta, with Iizuka City Hospital, and colleagues.

The authors note that the effectiveness of intravenous immunoglobulin (IVIG) within 10 days of onset of KD symptoms is well established, but the value of later treatment is not clear.  To investigate, they analyzed data from a recent nationwide survey of KD in Japan that included 23,337 patients diagnosed in 2007 and 2008.

The researchers identified 75 patients initially treated with IVIG on days 11-20 and matched them by age, sex, IVIG dose and institution to 75 patients who began treatment on days 4-8.

Changes in lab tests for systemic inflammation (WBC, % neutrophils, C-reactive protein) were similar in both groups, the report indicates.  However, during the convalescent period, coronary artery lesions were present in 1% of the early treatment group compared with 27% of the late treatment group.

“Because approximately half of patients in the late group had already developed CALs (coronary artery lesions) before initial IVIG, the proportion with CALs in this group was significantly higher than among all patients,” Dr. Muta and colleagues comment.

They conclude, “Therefore, late IVIG is less effective for preventing CALs.”

SOURCE: Coronary artery lesions develop if Kawasaki disease treatment is delayed

Pediatrics 2012;129.