What is the recommended dose of Intravenous Immunoglobulin (IVIG) for the treatment of Kawasaki disease?

From the Guidelines

The recommended dose of intravenous immunoglobulin (IVIG) for Kawasaki disease is 2 g/kg given as a single infusion over 10-12 hours, as this has been shown to reduce the prevalence of coronary artery abnormalities 1. This treatment should be administered within the first 10 days of illness onset, ideally within the first 7 days, when it is most effective at reducing the risk of coronary artery aneurysms. Some key points to consider when administering IVIG for Kawasaki disease include:

• IVIG should be given along with high-dose aspirin (80-100 mg/kg/day divided into four doses) during the acute phase 1.
• After the fever resolves, aspirin is typically reduced to a lower anti-platelet dose (3-5 mg/kg/day as a single dose) and continued for 6-8 weeks if there are no coronary abnormalities, or longer if coronary abnormalities are present.
• IVIG works by modulating cytokine production, neutralizing bacterial superantigens, and providing anti-inflammatory antibodies 1.
• Approximately 10-20% of patients may be resistant to initial IVIG therapy and require a second dose or additional treatments 1.
• Patients should be monitored for potential IVIG side effects including headache, aseptic meningitis, fluid overload, and hemolytic anemia 1.
• Cardiac echocardiography should be performed at diagnosis, 1-2 weeks after treatment, and 4-6 weeks after treatment to monitor for coronary artery abnormalities 1. It is also important to note that measles, mumps, and varicella immunizations should be deferred for 11 months after receiving high-dose IVIG 1.

From the Research

IVIG Dose for Kawasaki's Disease

• The recommended dose of IVIG for Kawasaki's disease is 2 gm/kg single dose, as stated in the study 2.
• A meta-analysis of 400 mg/kg/day for five days versus 2 gm/kg in a single dose showed a statistically significant reduction in coronary artery abnormalities (CAAs) at thirty days, with a relative risk (RR) of 4.47 (1.55 to 12.86) 2.
• Another study found a U-shaped association between IVIG dose and the proportion of CAAs, with the bottom of the curve at approximately 2.0 g/kg, suggesting that 2 g/kg is the optimal dose 3.
• The study 4 also found that high-dose IVIG regimens are probably associated with a reduced risk of CAA formation compared to ASA or medium- or low-dose IVIG regimens.
• The evidence suggests that the dose of 2 g/kg IVIG is effective in reducing the incidence of CAAs and is considered appropriate for the initial treatment of Kawasaki disease 3, 4.

Comparison of IVIG Doses

• A comparison of IVIG doses found that higher-dose regimens (2 gm/kg) probably reduce the incidence of CAAs compared to medium- or lower-dose regimens (400 mg/kg/day for five days) 2, 4.
• The study 3 found that IVIG doses below 2 g/kg (e.g., 1.8 g/kg) or above 2 g/kg (e.g., 2.4 g/kg) are associated with a higher proportion of CAAs.
• The optimal dose of IVIG for Kawasaki's disease is 2 g/kg, as it is associated with a lower risk of CAAs and is considered effective in reducing the incidence of CAAs 2, 3, 4.

IVIG Treatment Outcomes

• The study 2 found that IVIG treatment is associated with a significant reduction in the incidence of CAAs at thirty days, with a RR of 0.74 (0.61 to 0.90).
• The study 4 found that high-dose IVIG regimens are probably associated with a reduced risk of CAA formation compared to ASA or medium- or low-dose IVIG regimens.
• The evidence suggests that IVIG treatment is effective in reducing the incidence of CAAs and is considered appropriate for the initial treatment of Kawasaki disease 2, 3, 4.