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Not all commercially available preparations of intravenous immunoglobulin (IVIG), an antibody therap
NEW YORK (Reuters Health) - Not all commercially available preparations of intravenous immunoglobulin (IVIG), an antibody therapy, are equally effective in children with Kawasaki disease, an immune system disorder that can cause fever, rash, and possible complications of the heart and brain, new research shows.

The findings are based on a study of 437 children with the disease who were treated with one of four IVIG brands.
"Physicians should be cautious when using IVIG prepared with...beta-propiolactone or enzyme digestion to treat Kawasaki patients," Dr. Luan-Yin Chang from National Taiwan University Hospital in Taipei told Reuters Health.

In their study, the children who received IVIG prepared with beta-propiolactone had the poorest clinical outcomes and had the highest rates of heart complications. Such patients were nearly five times more likely to experience problems than those treated with other forms of IVIG, the team reports in the Journal of Pediatrics.

Children who received plasmin-digested IVIG had the second poorest response rates. The other children who received IVIG without chemical or enzyme digestion had better clinical outcomes.

Exactly how IVIG works against Kawasaki disease is unknown, but may involve binding to an antibody receptor on white blood cells. Beta-propiolactone preparation or enzyme digestion will affect " the shape of IVIG, possibly making less able to bind to this receptor, Chang said.

IVIG preparation had an impact on clinical outcome in children with Kawasaki disease and "intact form IVIG had better effects," Chang said. The study raises the question of whether the effectiveness of different IVIG preparations differs in other diseases, such as multiple sclerosis, the researcher added.

Dr. E. Richard Stiehm of the University of California, Los Angeles, comments in a related editorial that IVIG is a "valuable but expensive therapeutic agent and the clinical must be aware of brand differences, potential side effects, high cost, and limited availability."

SOURCE: Journal of Pediatrics, January 2006.