title: Targeted use of prednisolone with the second IVIG dose for refractory Kawasaki disease.
abstract: BACKGROUND
  Prednisolone (PSL) has been suggested to be useful for the treatment of Kawasaki disease (KD) resistant to i.v. immunoglobulin (IVIG), but much remains to be elucidated regarding its use.
  
  
  METHODS
  A total of 1087 subjects were involved in a two-study multicenter prospective investigation of the effects of acute phase therapy on IVIG-resistant KD. Subjects resistant to the first dose of IVIG were classified into high (≥10 mg/dL) and low (<10 mg/dL) serum C-reactive protein (CRP) groups after the first dose of IVIG.
  
  
  RESULTS
  In the first study, the efficacy of the second dose of IVIG in the high CRP group was significantly lower than in the low CRP group (47.8% vs 76.8%, P < 0.005). In the second study, PSL was co-administered with the second dose of IVIG to the high CRP patients (intensified regimen). The efficacy of the intensified regimen was similar to that of the second dose of IVIG in the low CRP group (79.4% vs 83.3%). Although the difference in the incidence of persistent coronary artery lesions (CAL) between the high and low CRP groups was significant in the first study (19.6% vs 3.0%, P < 0.005), it was not significant in the second study (8.8% vs 2.4%).
  
  
  CONCLUSIONS
  The targeted use of PSL with the second dose of IVIG in KD patients resistant to the first dose of IVIG and who are predicted to be resistant to the second dose of IVIG, appears to be effective.
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Pediatrics, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Harazaki
authors.affiliation: Department of Pediatrics, Shizuoka Saiseikai General Hospital, Shizuoka, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: Department of Pediatrics, Fujieda Municipal General Hospital, Shizuoka, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Asakura
authors.affiliation: Department of Pediatrics, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Hidemasa
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Department of Pediatrics, Shizuoka City Shimizu Hospital, Shizuoka, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kamimaki
authors.affiliation: Department of Pediatrics, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohkawara
authors.affiliation: Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan.
authors.forename: Naoe
authors.initials: N
authors.lastname: Akiyama
authors.affiliation: Department of Pediatrics, Seirei Numazu Hospital, Shizuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsurui
authors.affiliation: Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Iwashima
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimomura
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Morishita
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Meguro
authors.affiliation: Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Seto
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy*; D011239:Prednisolone / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D011239:Prednisolone
keywords: Kawasaki disease; i.v. immunoglobulin; prednisolone; refractory; second-line therapy