Pulse methylprednisolone with gammaglobulin as an initial treatment for acute Kawasaki disease.
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 >or=7 mg/dL, total bilirubin >or=0.9 mg/dL or aspartate aminotransferase >or=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.
Okada
Keiko
K
Department of Pediatric Hematology/Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-Hondori, Miyakojima-ku, Osaka 534-0021, Japan. keikubo@ped.med.osaka-u.ac.jp
Hara
Junichi
J
Maki
Ichiro
I
Miki
Kazunori
K
Matsuzaki
Kouji
K
Matsuoka
Taro
T
Yamamoto
Takehisa
T
Nishigaki
Toshinori
T
Kurotobi
Syunji
S
Sano
Tetsuya
T
D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D020551:Pulse Therapy, Drug; D012307:Risk Factors; D016896:Treatment Outcome; D005719:gamma-Globulins / Q000008:administration & dosage*
D005719:gamma-Globulins; D006493:Heparin; D002097:C-Reactive Protein; D001219:Aspartate Aminotransferases; D001663:Bilirubin; D008775:Methylprednisolone