IVGG and aspirin (ASA) is established therapy for KD, but optimal doses are uncertain. We reviewed U.S. and Japanese multicenter randomized controlled KD studies to assess efficacy of various IVGG and ASA regimens to prevent coronary abnormalities (CA). We analyzed 1629 acute KD patients from all 6 studies that included blinded echocardiographic assessments. In 868 Japanese patients treated with moderate dose (30-50mg/kg/d) ASA, CA were present at 30 days post KD onset in 27% given ASA alone, 18% with total IVGG < 1 gm/kg, 17% with total IVGG=1-1.2 gm/kg, and 5% with total IVGG=2gm/kg; corresponding values at 60 days were 18%, 14%, 10%, and 4%. In 761 U.S. patients treated with high dose (80-120mg/kg/d) ASA, CA prevalence 2 weeks after enrollment was 23% with ASA alone, 9% with total IVGG=1 gm/kg, 9% with total IVGG=1.6 gm/kg and 5% with total IVGG=2 gm/kg; corresponding values at 7 weeks post enrollment were 18%, 9%, 6%, and 4%. When all patients were combined, CA prevalence at the subacute stage was 26% with ASA alone, 18% with IVGG<1 gm/kg, 16% with IVGG=1-1.2 gm/kg, 9% with IVGG=1.6 gm/kg, and 5% with IVGG=2 gm/kg (r = -0.97, p = 0.0039); corresponding convalescent prevalences were 18%, 14%, 10%, 6%, and 4% (r = -0.99, p = 0.0003). These data indicate that the prevalence of CA in KD is related inversely to total IVGG dose and is independent of ASA dose. IVGG at 2 gm/kg with at least 30-50 mg/kg/d ASA provides maximum protection against development of CA following KD.
