060 - Variation in the Use of Adjunctive Agents for the Treatment of Kawasaki Disease

Publication Number: 60.7054

Michael A. Gardiner, University of California, San Diego School of Medicine, Santee, CA, United States; Chisato Shimizu, UCSD, La Jolla, CA, United States; Kyohka Sato, Niigata university, 5-32-12, Otsuka, Bunkyo-ku, Tokyo, Japan; Shoko Yamazaki, University of California, San Diego School of Medicine, San Diego, CA, United States; Jane C. Burns, UCSD, La Jolla, CA, United States; Adriana Tremoulet, University of California, San Diego School of Medicine, La Jolla, CA, United States

Background: Initial treatment of children with Kawasaki Disease (KD) with intravenous immunoglobulin (IVIG) decreases the incidence of coronary artery aneurysms (CAA). Various adjunctive agents are used to treat the 10-20% of children who are resistant to initial IVIG or are at high risk of developing CAA based on echocardiogram findings. Studies have evaluated the efficacy of repeat IVIG with or without corticosteroids, corticosteroids alone, infliximab, and other immunomodulatory agents. Both corticosteroids and infliximab have been shown to be more effective than repeat IVIG alone. To date there is insufficient data to directly compare corticosteroids and infliximab.

Objective: To describe the variation in use of adjunctive treatments for children with acute KD.

Design/Methods: Utilizing data from 45 hospitals in the Pediatric Health Information System (PHIS), we analyzed the first admission for children coded as KD who received IVIG and were discharged from a PHIS hospital between January 1, 2015 – December 31, 2019. The proportion of patients receiving repeat dosing of IVIG, corticosteroids, infliximab, and other adjunctive agents was analyzed for each of the treating hospitals. PHIS data from our institution was cross-referenced with an existing KD patient database to ensure accuracy.

Results: During the five-year study period, 8031 subjects were treated for KD with IVIG (median 161 per institution; range 30-577). 31% of all subjects were treated at one of the six highest KD volume hospital systems. Additional therapy was administered to 29.5% of subjects (95% CI 28.5 – 30.5%; Fig 1), with individual hospitals using adjunctive therapies to treat 14.2% - 82.9% of subjects. There was significant variation in the proportion of patients receiving repeat IVIG alone, infliximab, corticosteroids, and other agents (Fig 2).

Conclusion(s): There is significant practice variation in the use of adjunctive treatment of KD at the 45 PHIS hospitals. Head-to-head comparisons of adjunctive agents will be necessary to guide best practice.

Table
Kawasaki Disease (KD) Subject Characteristics

Figure 1
Adjunct therapies administered by all hospitals on first admission.

Figure 2
Kawasaki disease patients by hospital ordered highest to lowest volume and percentage of patients receiving adjunctive therapy on first hospital admission (A), and hospital use of repeat IVIG, steroids, and infliximab (B).