Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea.
Department of Pediatrics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon, 34943, Republic of Korea.
Paediatr Drugs. 2022 Nov;24(6):689-697. doi: 10.1007/s40272-022-00537-8. Epub 2022 Sep 26.
Intravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) is defined as persistent or recrudescent fever ≥36 hours after IVIG infusion. We have experienced an increase in IVIG resistance in patients with KD since the substitution of 10% IVIG for 5% IVIG. This study aimed to determine the independent association between increased IVIG resistance and 10% IVIG therapy.
Medical records of pediatric patients with KD were retrospectively reviewed. Clinical and laboratory characteristics were compared between patients receiving 5% IVIG therapy and those receiving 10% IVIG therapy. Between IVIG-responsive and IVIG-resistant patients, a multivariate analysis was performed to determine the independent factors for IVIG resistance.
A total of 119 patients were included in this study: 81 (68.1%) and 38 (31.9%) patients received 5% and 10% IVIG therapy, respectively. IVIG resistance was identified in 34 (28.6%) patients: 44.7% of patients receiving 10% IVIG therapy and 21.0% of patients receiving 5% IVIG therapy (p = 0.008). The clinical manifestations and outcomes were comparable between patients who received 5% IVIG therapy and those who received 10% IVIG therapy. IVIG resistance was significantly associated with fewer fever days at IVIG administration (p = 0.032), a higher percentage of neutrophils (p = 0.013), and 10% IVIG treatment (p = 0.004) in the multivariate analysis.
10% IVIG therapy was significantly associated with increased reporting of IVIG resistance. However, the increase in patients with fever patterns consistent with IVIG resistance seemed to represent adverse febrile reactions resulting from using high-concentration IVIG rather than increased severity of KD.
川崎病（KD）患者静脉注射免疫球蛋白（IVIG）耐药的定义为 IVIG 输注后持续或复发发热≥36 小时。自从用 10%IVIG 替代 5%IVIG 以来，我们发现 KD 患者的 IVIG 耐药性有所增加。本研究旨在确定增加的 IVIG 耐药性与 10%IVIG 治疗之间的独立相关性。
回顾性分析儿科 KD 患者的病历。比较接受 5%IVIG 治疗和接受 10%IVIG 治疗的患者的临床和实验室特征。对 IVIG 反应良好和 IVIG 耐药的患者进行多变量分析，以确定 IVIG 耐药的独立因素。
本研究共纳入 119 例患者：81 例（68.1%）和 38 例（31.9%）患者分别接受 5%和 10%IVIG 治疗。34 例（28.6%）患者出现 IVIG 耐药：10%IVIG 治疗组患者中耐药的比例为 44.7%，5%IVIG 治疗组患者中耐药的比例为 21.0%（p=0.008）。接受 5%IVIG 治疗和接受 10%IVIG 治疗的患者的临床表现和结局相似。在多变量分析中，IVIG 耐药与 IVIG 给药时发热天数较少（p=0.032）、中性粒细胞比例较高（p=0.013）和接受 10%IVIG 治疗（p=0.004）显著相关。
10%IVIG 治疗与 IVIG 耐药报告的增加显著相关。然而，发热模式与 IVIG 耐药一致的患者增加似乎代表了使用高浓度 IVIG 引起的不良反应，而不是 KD 严重程度的增加。
