Abstract
Approximately 15–20% of patients with Kawasaki disease (KD) are not responsive to high-dose intravenous gammaglobulin (IVIG). We have previously reported a predictive method for identifying IVIG-non-responsive patients (high-risk KD patients). We determined the safety and effectiveness of pulse methylprednisolone with high-dose IVIG (mPSL+IVIG) as a primary treatment for high-risk KD patients. Sixty-two high-risk KD patients were treated with pulse methylprednisolone 30 mg/kg over 2 h, followed by IVIG 2 g/kg over 24 h (mPSL+IVIG group) and were compared with a historical control group of 32 high-risk patients treated with IVIG 2 g/kg alone at the participating hospitals before this study was opened (IVIG group). High-risk patients were identified with at least two of three predictors (C-reactive protein ≥7 mg/dL, total bilirubin ≥0.9 mg/dL or aspartate aminotransferase ≥200 IU/L). Sixty-six percent (95% confidence interval [CI] 54–78%) of patients had a prompt defervescence in the mPSL+IVIG group compared with 44% (95% CI 26–62%) for the IVIG group (p = 0.048). Coronary artery lesions were observed in 24.2% (95% CI 13.2–35.2%) and 46.9% (95% CI 28.6–65.2%) of patients in the mPSL+IVIG and IVIG groups, respectively (p = 0.025). This is the first report showing that mPSL+IVIG is effective and safe as a primary treatment for high-risk KD patients.
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Abbreviations
- IVIG:
-
Intravenous gammaglobulin
- KD:
-
Kawasaki disease
- mPSL:
-
Methylprednisolone
References
Cheung YF, Yung TC, Tam SC, Ho MH, Chau AK (2004) Novel and traditional cardiovascular risk factors in children after Kawasaki disease: implications for premature atherosclerosis. J Am Coll Cardiol 43:120–124
Dale RC, Saleem MA, Daw S, Dillon MJ (2000) Treatment of severe complicated Kawasaki disease with oral prednisolone and aspirin. J Pediatr 137:723–726
Dhillon R, Clarkson P, Donald AE, Powe AJ, Nash M, Novelli V, Dillon MJ, Deanfield JE (1996) Endothelial dysfunction late after Kawasaki disease. Circulation 94:2103–2106
Durongpisitkul K, Soongswang J, Laohaprasitiporn D, Nana A, Prachuabmoh C, Kangkagate C (2003) Immunoglobulin failure and retreatment in Kawasaki disease. Pediatr Cardiol 24:145–148
Furusho K, Kamiya T, Nakano H, Kiyosawa N, Shinomiya K, Hayashidera T, Tamura T, Hirose O, Manabe Y, Yokoyama T, Kawarano M, Baba K, Mori C (1984) High-dose intravenous gammaglobulin for Kawasaki disease. Lancet 2:1055–1058
Inoue Y, Okada Y, Shinohara M, Kobayashi T, Kobayashi T, Tomomasa T, Takeuchi K, Morikawa A (2006) A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: clinical course and coronary artery outcome. J Pediatr 149:336–341
Jibiki T, Terai M, Kurosaki T, Nakajima H, Suzuki K, Inomata H, Terashima I, Honda T, Yasukawa K, Hamada H, Kohno Y (2004) Efficacy of intravenous immune globulin therapy combined with dexamethasone for the initial treatment of acute Kawasaki disease. Eur J Pediatr 163:229–233
Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; American Heart Association (2004) Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 114:1708–1733
Newburger JW, Sleeper LA, McCrindle BW, Minich LL, Gersony W, Vetter VL, Atz AM, Li JS, Takahashi M, Baker AL, Colan SD, Mitchell PD, Klein GL, Sundel RP; Pediatric Heart Network Investigators (2007) Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med 15:663–675
Sano T, Kurotobi S, Matsuzaki K, Yamamoto T, Maki I, Miki K, Kogaki S, Hara J (2007) Prediction of non-responsiveness to standard high-dose gamma-globulin therapy in patients with acute Kawasaki disease before starting initial treatment. Eur J Pediatr 166:131–137
Wallace CA, French JW, Kahn SJ, Sherry DD (2000) Initial intravenous gammaglobulin treatment failure in Kawasaki disease. Pediatrics 105:E78
Wright DA, Newburger JW, Baker A, Sundel RP (1996) Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 128:146–149
Acknowledgements
We thank Shigetoyo Kogaki, Reiko Yabuta, Nobuhiro Kawakami, Masaru Iwaki and Kazuki Tanaka for the acquisition of the clinical data, and Tokuko Okuda for assistance.
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Okada, K., Hara, J., Maki, I. et al. Pulse methylprednisolone with gammaglobulin as an initial treatment for acute Kawasaki disease. Eur J Pediatr 168, 181–185 (2009). https://doi.org/10.1007/s00431-008-0727-9
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DOI: https://doi.org/10.1007/s00431-008-0727-9