title: Corticosteroid pulse combination therapy for refractory Kawasaki disease: a randomized trial.
abstract: OBJECTIVE
  This study examined the clinical efficacy and safety of intravenous methylprednisolone-pulse plus intravenous immunoglobulin (IVIG) combination therapy (IVMP+IVIG) for the initial treatment of patients predicted to have refractory Kawasaki disease (KD).
  
  
  METHODS
  One hundred twenty-two patients with KD were studied at Kitasato University. Refractory KD was predicted at diagnosis using the Egami score, and the patients were randomly divided to receive either IVMP+IVIG or IVIG alone. The Egami score is used to predict refractory KD patients before treatment using the patient's age, days of illness, platelet count, C-reactive protein, and alanine aminotransferase level (cutoff: ≥3 points; 78% sensitivity and 76% specificity).
  
  
  RESULTS
  Forty-eight patients (39.3%) were predicted to have refractory KD on the basis of the Egami score. The predicted IVIG responders (n = 74) received the standard therapy. The 48 predicted refractory KD patients were randomly assigned to a single-IVIG group (n = 26) or an IVMP+IVIG group (n = 22). Nineteen of the 22 patients (86.4%) in the IVMP+IVIG group had a prompt defervescence compared with 6 of the 26 patients (23.1%) in the single-IVIG group. The number of patients who had a z score ≥2.5 at 1 month was significantly higher in the single-IVIG group than in the IVMP+IVIG group. No serious adverse events were observed in either treatment group.
  
  
  CONCLUSIONS
  This study demonstrated that IVMP+IVIG therapy is safe and effective for KD patients predicted as refractory.
authors.affiliation: Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato Mimami-ku, Sagamihara-shi, Kanagawa-ken 252-0374, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Ogata
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ogihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
authors.forename: Shinya
authors.initials: S
authors.lastname: Kon
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Akiyama
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ishii
mesh_terms: D002675:Child, Preschool; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D020551:Pulse Therapy, Drug
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone