The efficacy of intravenous gamma globulin (IVGG) for treatment of Kawasaki disease
(KD) is clearly established. In a metaanalysis, we reviewed U.S. and Japanese multicenter,
randomized controlled studies regarding the effect of various doses of IVGG with aspirin
administered within the first 7 to 10 days of illness on the prevalence of coronary
artery abnormalities in KD. We studied 1629 patients with acute KD from the six reported
studies that included blinded echocardiographic assessments. In 868 Japanese patients
treated with moderate-dose aspirin (30 to 50 mg/kg per day), the prevalence of coronary
abnormalities at the subacute stage (illness day 30) was 26.8% with aspirin alone,
18.1% with total IVGG dose < 1 gm/kg, 17.3% with total IVGG of 1.0 to 1.2 g/kg, and
5.3% with total IVGG of 2 gm/kg; the corresponding prevalence at the convalescent
stage of illness (illness day 60) was 17.5%, 13.5%, 9.8%, and 3.5%, respectively.
In 761 U.S. patients treated with high-dose aspirin (80 to 120 mg/kg per day), the
prevalence of coronary abnormalities at the subacute stage (2 to 3 weeks after enrollment)
was 23.0% with aspirin alone, 9.0% with total IVGG of 1.0 gm/kg, 8.6% with total IVGG
of 1.6 gm/kg, and 4.6% with total IVGG of 2.0 gm/kg; corresponding prevalence at the
convalescent stage (6 to 8 weeks after enrollment) was 17.7%, 9.0%, 6.3%, and 3.8%,
respectively. When all data for the 1629 patients were combined, the prevalence at
the subacute stage was 25.8% with aspirin alone, 18.1% with IVGG < 1 gm/kg, 15.7%
with IVGG of 1 to 1.2 gm/kg, 8.6% with IVGG of 1.6 gm/kg, and 4.8% with IVGG of 2
gm/kg (adjusted R2 = 0.966, p = 0.0017); corresponding prevalence at the convalescent
stage was 17.6%, 13.5%, 9.7%, 6.3%, and 3.8%, respectively (adjusted R2 = 0.993, p
= 0.0602). The prevalence of coronary abnormalities was inversely related to the total
dose of IVGG and was independent of the aspirin dose. We conclude that 2 gm/kg IVGG
combined with at least 30 to 50 mg/kg per day aspirin provides maximum protection
against development of coronary abnormalities after KD.