title: Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute Kawasaki disease.
abstract: OBJECTIVE
  To determine the most effective first-line rescue therapy for intravenous immunoglobulin (IVIG) nonresponders, using IVIG, prednisolone, or both, to prevent coronary artery abnormalities (CAAs).
  
  
  METHODS
  We retrospectively reviewed the clinical records of 359 consecutive patients with Kawasaki disease who failed to respond to initial IVIG.
  
  
  RESULTS
  CAAs up to 1 month after treatment were less common in the IVIG+prednisolone group (15.9%) than in the IVIG group (28.7%, P = .005) and the prednisolone group (30.6%, P = .01). The IVIG+prednisolone group had significantly lower risks of failing to respond to first-line rescue therapy (aOR 0.16, 95% CI 0.09-0.31), CAAs up to 1 month (aOR 0.46, 95% CI 0.27-0.90), and CAAs at 1 month (aOR 0.40, 95% CI 0.18-0.91) than the IVIG group. In the prednisolone and IVIG+prednisolone groups, risk score, day of illness at first-line rescue therapy, prednisolone monotherapy, and resistance to first-line rescue therapy were independent risk factors for CAA. Sex and resistance to first-line rescue therapy were independent risk factors in the IVIG group.
  
  
  CONCLUSIONS
  IVIG+prednisolone may be superior to IVIG or prednisolone as first-line rescue therapy in the treatment of IVIG nonresponders. To establish the efficacy of rescue therapy with IVIG+prednisolone following nonresponse to initial IVIG, a prospective randomized trial is warranted.
authors.affiliation: Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. torukoba@nifty.com
authors.forename: Tohru
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Tomio
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Morikawa
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ikeda
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Seki
authors.forename: Shinya
authors.initials: S
authors.lastname: Shimoyama
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Ishii
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kimiko
authors.initials: K
authors.lastname: Nakajima
authors.forename: Naoko
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Arakawa
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D011239:Prednisolone
keywords: C-reactive protein; CAA; CRP; Coronary artery abnormality; IL; IVIG; Interleukin; Intravenous immunoglobulin; KD; Kawasaki disease; Methylprednisolone; mPSL