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Intravenous immunoglobulin in acute rheumatic fever: a randomized controlled trial
L M Voss1, N J Wilson, J M Neutze
1Starship Children's Hospital, Auckland, New Zealand. ssinfect@ahsl.co.nz
Circulation
|February 7, 2001
Summary
Intravenous immunoglobulin (IVIG) did not improve outcomes for acute rheumatic fever (ARF) patients with carditis. This study found no significant differences in clinical or echocardiographic measures over 12 months.
Area of Science:
- Pediatrics
- Rheumatology
- Immunology
Background:
- Acute rheumatic fever (ARF) is a leading cause of acquired heart disease in children globally.
- Current treatments do not alter the acute illness's clinical outcome.
- Immunological factors are implicated in ARF pathogenesis, suggesting a potential role for immunomodulators like IVIG.
Purpose of the Study:
- To investigate if intravenous immunoglobulin (IVIG) modifies the natural history of ARF.
- To determine if IVIG reduces the extent and severity of carditis in ARF patients.
Main Methods:
- A prospective, double-blind, randomized, placebo-controlled trial was conducted.
- Patients received either IVIG (1 g/kg on days 1-2, 0.4 g/kg on days 14, 28) or a placebo.
- Evaluations (clinical, laboratory, echocardiographic) were performed at multiple time points up to 52 weeks.
Main Results:
- Fifty-nine patients were treated; 39 had carditis and/or polyarthritis.
- No significant difference was observed in the normalization of inflammatory markers (ESR, acute-phase proteins) at 6 weeks.
- Cardiac outcomes, including valve involvement and regurgitation severity at 1 year, showed no significant difference between IVIG and placebo groups.
Conclusions:
- Intravenous immunoglobulin (IVIG) did not alter the natural history of acute rheumatic fever (ARF).
- No detectable differences in clinical, laboratory, or echocardiographic parameters were observed over 12 months.
- IVIG is not effective in modifying ARF carditis outcomes.
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