Discussion
head to head comparison of two IVIG, kawasaki disease, coronary aneurysms, primary immunodeficiency diseases, PID, coronavirus disease 2019
PID, IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP), RECURRENCE, CORONAVIRUS DISEASE 2019, ENTEROVIRUS, RENAL FAILURE, KAWASAKI DISEASE, CORONARY ANEURYSMS, DISEASE, INFLAMMATORY DISEASE
This longitudinal cohort is a large nationwide comparative effectiveness study for IVIG (Privigen and TBSF) in the acute phase of KD. In this study, we conduct a head to head comparison of two IVIG, TBSF and Privigen. Privigen contributed to a lower IVIG resistance rate and reduced coronary artery involvement comparing to TBSF. KD recurrence did not differ significantly. The result showed Privigen might possibly offer better clinical outcome in acute KD.Numerous studies have demonstrated the vital role of IVIG replacement therapy and immunomodulation for primary immunodeficiency diseases (PID), idiopathic thrombocytopenic purpura (ITP), kawasaki disease (KD), and allogeneic bone marrow transplantation. Owing to its activity in the regulation of the immune system, it has clinical utility in a range of autoimmune and inflammatory diseases, even as an off-label adjunctive therapy in patients with coronavirus disease 2019 (COVID-19) infectionTBSF derived from Taiwanese plasma was desirable for the treatment of patients infected with Enterovirus 71Commercial IVIG products are available at concentrations of 3%, 5%, 6%, 9%, 10%, and 12%. For initial treatment in elderly patients or in those who may be at risk of renal failure, a lower concentration of infusion should be chosenThe biological mechanisms of IVIG in the treatment of KD are unclear. There are several hypotheses. It has been postulated that the Fc portion of the immunoglobulin G molecule play a therapeutic role in KD through immune complex neutralization, opsonic activity enhancement, and complement modulationThere are four subclasses of IgG in humans: IgG1, IgG2, IgG3, and IgG4. The predominant isotype is IgG1, accounting for more than 60% of the total IgG in human serumThe enzymatic process of β-propiolactonation is believed to be associated with an elevated risk of IVIG resistance. This poorer immunomodulation function in comparison with the ion exchange procedure is ascribed to the modifications occurring in the Fc portion of immunoglobulin during the alkylation and acylation of proteins in β-propiolactonationPreservation in acid conditions (acidification) is prone to increase the risk of coronary aneurysms because a substantial infusion of acidic fluids may lead to a reduction in intracellular tone and an increase in vascular tensionKD primarily affects children younger than 5 years of age, and the peak incidence occurred from 6 months to 2 years of age, which includes more than 50% of all KD patientsPotential limitations inherent to this retrospective design should be noted. The large-scale, population-based database (NHIRD) used in this study does not contain information on certain variables, such as medical history, physical examination, laboratory testing, defervescence, duration of hospital stay, and electrocardiogram cardiac assessments. The severity of cardiac condition (coronary artery Z-score or absolute dimension) could not be identified from the diagnosis codes alone. IVIG resistance was defined by a total dose exceeding 26 g which may cause misclassification affected by weight variation. Disease severity and the subsequent treatment, which could potentially impact outcomes, such as steroid therapy, biological products including infliximab, ulinastatin therapy, immunosuppressive agent cyclosporine, and plasma exchange remain undisclosed in our study. There are also no laboratory data in the NHIRD. Therefore, high-risk populations cannot be identified.