Ulinastatin therapy in kawasaki disease.
OBJECTIVE
Ulinastatin therapy may be an additional therapeutic approach to Kawasaki disease (KD). This study set out to determine whether primary intravenous ulinastatin therapy has more beneficial effects than intravenous immunoglobulin (IVIG) therapy in the acute phase of KD, and whether addition of ulinastatin to IVIG might improve outcomes in KD.


METHODS
Patients were included in the study if they had a diagnosis of KD with a Harada's score that predicted coronary artery lesions. Subjects were selected to receive either primary ulinastatin therapy (30 000 U/kg/day for 3 days) or IVIG therapy (1 g/kg/dose) using sealed envelopes. Of the 27 study subjects, 18 were assigned to the ulinastatin group, and nine to the IVIG group. IVIG therapy could be added to ulinastatin therapy if patients experienced adverse effects of ulinastatin, were found to have complicated coronary artery lesions, or developed prolonged fever or elevated white blood cell counts or C-reactive protein levels.


RESULTS
More patients receiving IVIG as primary therapy had reduced fever and C-reactive protein levels than patients receiving ulinastatin as primary therapy. Five patients in the ulinastatin group (28%) improved without additional IVIG therapy. These patients had lower white blood cell counts and C-reactive protein levels on admission.


CONCLUSIONS
Primary ulinastatin therapy prevented coronary artery lesions in only 28% of cases of KD with a Harada's score predictive of such lesions. Primary ulinastatin therapy may not be the treatment of first choice for preventing coronary artery lesions in patients with KD.
Iwashima
Satoru
S
Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan. iwashima@hama-med.ac.jp
Seguchi
Masashi
M
Matubayashi
Tadashi
T
Ohzeki
Takehiko
T
D000208:Acute Disease; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D002675:Child, Preschool; D003327:Coronary Disease / Q000209:etiology; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D006023:Glycoproteins / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D010865:Pilot Projects; D012720:Severity of Illness Index; D014361:Trypsin Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*