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Intravenous immune globulin plus corticosteroids in refractory Kawasaki disease.
MedLine Citation:
PMID:  21342358     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: The aim of this study was to investigate the efficacy of intravenous immune globulin (IVIG) therapy combined with corticosteroids for additional treatment of acute Kawasaki disease (KD) unresponsive to initial IVIG treatment. Methods: In prospective 50 KD patients, 6 IVIG nonresponders without clinical improvement within 24-48 hours after completion of initial IVIG, received 2 g/kg IVIG concurrently with 2 mg/kg intravenous prednisolone sodium succinate (PSL) until normalization of C-reactive protein values. Treatment was then changed to oral PSL, which was tapered over time. Clinical and coronary-artery lesion(CAL) outcomes were compared to the outcomes of 13 IVIG nonresponders who received heterogeneous additional therapies in retrospective 125 KD patients. In addition, the scoring system of Kobayashi et al. for prediction of nonresponsiveness to initial IVIG treatment was retrospectively verified in 175 KD subjects, consisted of 50 prospective and 125 retrospective patients in order to evaluate the efficacy of the retreatment regimen. Results: Incidence of CAL in study patients was lower than control patients, although differences were not significant both in acute (within a month) (7/13(53.8%) vs. 1/6(16.7%), P = 0.177) and convalescent stage (after a month) (4/13(30.8%) vs. 0/6(0.0%), P = 0.255). By the nonresponder prediction system, the scores of 13 control and 6 study patients before initial IVIG treatment were similar (5.3 ± 3.1 vs. 7.2 ± 1.9, P= 0.200). No serious adverse effects related to each treatment were noted in patients of any group. Conclusions: Additional IVIG combined with concurrent PSL appears to be safe and worth evaluation for the treatment of acute KD unresponsive to initial IVIG treatment.
Authors:
Toshiaki Jibiki; Izumi Kato; Tadashi Shiohama; Katsuaki Abe; Satoshi Anzai; Nobue Takeda; Ken-Ichi Yamaguchi; Masaki Kanazawa; Tomomichi Kurosaki
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-22
Journal Detail:
Title:  Pediatrics international : official journal of the Japan Pediatric Society     Volume:  -     ISSN:  1442-200X     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886002     Medline TA:  Pediatr Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors. Pediatrics International © 2011 Japan Pediatric Society.
Affiliation:
Department of Pediatrics, Chiba Kaihin Municipal Hospital, Chiba, Japan.
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