February 13, 2006

Antibody therapy for Kawasaki disease vary by brand

By Megan Rauscher

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

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

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

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.