title: Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin.
abstract: This study aimed to determine the effects of intravenous methylprednisolone pulse (IVMP) therapy on cytokine levels in patients with acute Kawasaki disease (KD) unresponsive to initial intravenous immunoglobulin (IVIG) therapy. Fifteen KD patients unresponsive to initial IVIG, 2 g/kg/day, were randomized to receive IVMP (n = 7), 30 mg/kg/day for 3 days or additional IVIG (n = 8), 2 g/kg/day, and plasma cytokine levels were compared. The fraction of febrile patients was significantly lower in the IVMP group than in the additional IVIG group on day 2 (0/7 vs. 3/8, p = 0.03), but not on day 4 and later (3/7 vs. 4/8, p = 1.00) because of recurrent fever. The prevalence of coronary lesions was similar between the two groups (2/7 vs. 2/8, p = 1.00). The ratios of plasma levels of tumor necrosis factor-alpha and monocyte chemoattractant protein-1 to those at enrollment (defined as day 1) were significantly lower in the IVMP group on day 4 (0.50 +/- 0.27 vs. 1.01 +/- 0.46, 0.53 +/- 0.39 vs. 0.93 +/- 0.44, p = 0.02 and 0.045, respectively), but not on day 7 (0.54 +/- 0.34 vs. 0.88 +/- 0.39, 0.76 +/- 0.39 vs. 0.61 +/- 0.17, p = 0.07 and 0.83, respectively). The ratios of interleukin-2 receptor, interleukin-6, and vascular endothelial cell growth factor to those at enrollment did not differ significantly between the two groups. In conclusion, for KD patients unresponsive to initial IVIG, IVMP suppresses cytokine levels faster, but subsequently similarly, compared with additional IVIG.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Japan. miura@chp-kiyose-tokyo.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Miura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kohno
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohki
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yoshiba
authors.forename: Akinori
authors.initials: A
authors.lastname: Sugaya
authors.forename: Masaaki
authors.initials: M
authors.lastname: Satoh
mesh_terms: D000208:Acute Disease; D000328:Adult; D018932:Chemokine CCL2 / Q000097:blood; D016207:Cytokines / Q000097:blood*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000188:drug therapy*; D020551:Pulse Therapy, Drug; D015375:Receptors, Interleukin-2 / Q000097:blood; D013256:Steroids / Q000008:administration & dosage*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D018932:Chemokine CCL2; D016207:Cytokines; D016756:Immunoglobulins, Intravenous; D015850:Interleukin-6; D015375:Receptors, Interleukin-2; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D042461:Vascular Endothelial Growth Factor A; D008775:Methylprednisolone