PMID- 11157692
OWN - NLM
STAT- MEDLINE
DCOM- 20010426
LR  - 20190623
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 103
IP  - 3
DP  - 2001 Jan 23
TI  - Intravenous immunoglobulin in acute rheumatic fever: a randomized controlled 
      trial.
PG  - 401-6
AB  - BACKGROUND: Acute rheumatic fever (ARF) remains the leading cause of acquired 
      heart disease in children worldwide. No therapeutic agent has been shown to alter 
      the clinical outcome of the acute illness. Immunological mechanisms appear to be 
      involved in the pathogenesis of ARF. Intravenous immunoglobulin (IVIG), a proven 
      immunomodulator, may benefit cardiac conditions of an autoimmune nature. We 
      investigated whether IVIG modified the natural history of ARF by reducing the 
      extent and severity of carditis. METHODS AND RESULTS: This prospective, 
      double-blind, randomized, placebo-controlled trial evaluated IVIG in patients 
      with a first episode of rheumatic fever, stratifying patients by the presence and 
      severity of carditis before randomization. Patients were randomly allocated to 
      receive 1 g/kg IVIG on days 1 and 2 and 0.4 g/kg on days 14 and 28, or they 
      received a placebo infusion. Clinical, laboratory, and echocardiographic 
      evaluation was performed at 0, 2, 4, 6, 26, and 52 weeks. Fifty-nine patients 
      were treated, of whom 39 had carditis (including 4 subclinical) and/or migratory 
      polyarthritis (n=39). There was no difference between groups in the rate of 
      normalization of the erythrocyte sedimentation rate or acute-phase proteins at 
      the 6-week follow-up. On echocardiography, 59% in the IVIG group and 69% in the 
      placebo group had carditis at baseline. There was no significant difference in 
      the cardiac outcome, including the proportion of valves involved, or in the 
      severity of valvar regurgitation at 1 year. At 1 year, 41% of the IVIG and 50% of 
      the placebo group had carditis. CONCLUSIONS: IVIG did not alter the natural 
      history of ARF, with no detectable difference in the clinical, laboratory, or 
      echocardiographic parameters of the disease process during the subsequent 12 
      months.
FAU - Voss, L M
AU  - Voss LM
AD  - Starship Children's Hospital, Auckland, New Zealand. ssinfect@ahsl.co.nz
FAU - Wilson, N J
AU  - Wilson NJ
FAU - Neutze, J M
AU  - Neutze JM
FAU - Whitlock, R M
AU  - Whitlock RM
FAU - Ameratunga, R V
AU  - Ameratunga RV
FAU - Cairns, L M
AU  - Cairns LM
FAU - Lennon, D R
AU  - Lennon DR
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Acute-Phase Proteins)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Acute Disease
MH  - Acute-Phase Proteins/analysis
MH  - Blood Sedimentation
MH  - C-Reactive Protein/analysis
MH  - Child
MH  - Double-Blind Method
MH  - Echocardiography
MH  - Humans
MH  - Immunoglobulins, Intravenous/*therapeutic use
MH  - Myocarditis/pathology
MH  - Prospective Studies
MH  - Rheumatic Fever/blood/pathology/*therapy
MH  - Time Factors
EDAT- 2001/02/07 11:00
MHDA- 2001/05/11 10:01
CRDT- 2001/02/07 11:00
PHST- 2001/02/07 11:00 [pubmed]
PHST- 2001/05/11 10:01 [medline]
PHST- 2001/02/07 11:00 [entrez]
AID - 10.1161/01.cir.103.3.401 [doi]
PST - ppublish
SO  - Circulation. 2001 Jan 23;103(3):401-6. doi: 10.1161/01.cir.103.3.401.