Re-treatment for immune globulin-resistant Kawasaki disease

A comparative study of additional immune globulin and steroid pulse therapy

K. Hashino, M. Ishii, M. Iemura, Teiji Akagi, H. Kato

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Background: We compared the efficacy and safety of additional intravenous immune globulin (IVIG) therapy with steroid pulse therapy in patients with IVIG-resistant Kawasaki disease. Methods: Two-hundred and sixty-two consecutive patients had been treated with a single dose of IVIG (2 g/kg) and aspirin (30 mg/kg per day). Thirty-five patients (13.4%) were not clinical responders to the initial IVIG treatment. They received an additional IVIG treatment (1 g/kg) within 48 h after the initial treatment. Seventeen patients (6.5%) did not respond to the additional IVIG treatment. We randomly divided these patients into two groups: group 1 consisted of eight patients who were treated with a single additional dose of IVIG (1 g/kg), while group 2 consisted of nine patients who were treated with steroid pulse therapy. Results: The IVIG-resistant patients had a high incidence of coronary artery lesions (CAL; 48.6%). Five patients (62.5%) in group 1 had CAL, including two patients who each had a giant aneurysm and three patients who each had a small aneurysm. Seven patients (77.8%) in group 2 had CAL, including two patients who each had a giant aneurysm, two patients who each had a small coronary aneurysm and three patients who each showed transient dilatation during steroid pulse therapy. There was no significant difference in the incidence of CAL between the two groups. The duration of high fever in group 2 (1.4 ± 0.7 days) was significantly shorter than in group 1 (4.8 ± 3.4 days; P <0.05). The medical costs for the treatment of patients in group 2 (¥113 012 ± 22 084) were significantly lower than those for group 1 (¥144 194 ± 12 914; P <0.05). Conclusions: Steroid pulse therapy may be useful in the treatment of patients with IVIG-resistant Kawasaki disease who experience prolonged fever. However, transient dilatation of the coronary artery is observed during steroid pulse therapy, so careful echocardiographic examination should be performed for those patients receiving steroid pulse therapy for the sake of early detection of coronary artery abnormalities.

Original languageEnglish
Pages (from-to)211-217
Number of pages7
JournalPediatrics International
Volume43
Issue number3
DOIs
Publication statusPublished - 2001
Externally publishedYes

Fingerprint

Mucocutaneous Lymph Node Syndrome
Immunoglobulins
Steroids
Intravenous Immunoglobulins
Therapeutics
Aneurysm
Coronary Vessels
Dilatation
Fever
Coronary Aneurysm
Incidence

Keywords

  • Immune globulin therapy
  • Kawasaki disease
  • Steroid pulse therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Re-treatment for immune globulin-resistant Kawasaki disease : A comparative study of additional immune globulin and steroid pulse therapy. / Hashino, K.; Ishii, M.; Iemura, M.; Akagi, Teiji; Kato, H.

In: Pediatrics International, Vol. 43, No. 3, 2001, p. 211-217.

Research output: Contribution to journalArticle

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abstract = "Background: We compared the efficacy and safety of additional intravenous immune globulin (IVIG) therapy with steroid pulse therapy in patients with IVIG-resistant Kawasaki disease. Methods: Two-hundred and sixty-two consecutive patients had been treated with a single dose of IVIG (2 g/kg) and aspirin (30 mg/kg per day). Thirty-five patients (13.4{\%}) were not clinical responders to the initial IVIG treatment. They received an additional IVIG treatment (1 g/kg) within 48 h after the initial treatment. Seventeen patients (6.5{\%}) did not respond to the additional IVIG treatment. We randomly divided these patients into two groups: group 1 consisted of eight patients who were treated with a single additional dose of IVIG (1 g/kg), while group 2 consisted of nine patients who were treated with steroid pulse therapy. Results: The IVIG-resistant patients had a high incidence of coronary artery lesions (CAL; 48.6{\%}). Five patients (62.5{\%}) in group 1 had CAL, including two patients who each had a giant aneurysm and three patients who each had a small aneurysm. Seven patients (77.8{\%}) in group 2 had CAL, including two patients who each had a giant aneurysm, two patients who each had a small coronary aneurysm and three patients who each showed transient dilatation during steroid pulse therapy. There was no significant difference in the incidence of CAL between the two groups. The duration of high fever in group 2 (1.4 ± 0.7 days) was significantly shorter than in group 1 (4.8 ± 3.4 days; P <0.05). The medical costs for the treatment of patients in group 2 (¥113 012 ± 22 084) were significantly lower than those for group 1 (¥144 194 ± 12 914; P <0.05). Conclusions: Steroid pulse therapy may be useful in the treatment of patients with IVIG-resistant Kawasaki disease who experience prolonged fever. However, transient dilatation of the coronary artery is observed during steroid pulse therapy, so careful echocardiographic examination should be performed for those patients receiving steroid pulse therapy for the sake of early detection of coronary artery abnormalities.",
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AU - Kato, H.

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N2 - Background: We compared the efficacy and safety of additional intravenous immune globulin (IVIG) therapy with steroid pulse therapy in patients with IVIG-resistant Kawasaki disease. Methods: Two-hundred and sixty-two consecutive patients had been treated with a single dose of IVIG (2 g/kg) and aspirin (30 mg/kg per day). Thirty-five patients (13.4%) were not clinical responders to the initial IVIG treatment. They received an additional IVIG treatment (1 g/kg) within 48 h after the initial treatment. Seventeen patients (6.5%) did not respond to the additional IVIG treatment. We randomly divided these patients into two groups: group 1 consisted of eight patients who were treated with a single additional dose of IVIG (1 g/kg), while group 2 consisted of nine patients who were treated with steroid pulse therapy. Results: The IVIG-resistant patients had a high incidence of coronary artery lesions (CAL; 48.6%). Five patients (62.5%) in group 1 had CAL, including two patients who each had a giant aneurysm and three patients who each had a small aneurysm. Seven patients (77.8%) in group 2 had CAL, including two patients who each had a giant aneurysm, two patients who each had a small coronary aneurysm and three patients who each showed transient dilatation during steroid pulse therapy. There was no significant difference in the incidence of CAL between the two groups. The duration of high fever in group 2 (1.4 ± 0.7 days) was significantly shorter than in group 1 (4.8 ± 3.4 days; P <0.05). The medical costs for the treatment of patients in group 2 (¥113 012 ± 22 084) were significantly lower than those for group 1 (¥144 194 ± 12 914; P <0.05). Conclusions: Steroid pulse therapy may be useful in the treatment of patients with IVIG-resistant Kawasaki disease who experience prolonged fever. However, transient dilatation of the coronary artery is observed during steroid pulse therapy, so careful echocardiographic examination should be performed for those patients receiving steroid pulse therapy for the sake of early detection of coronary artery abnormalities.

AB - Background: We compared the efficacy and safety of additional intravenous immune globulin (IVIG) therapy with steroid pulse therapy in patients with IVIG-resistant Kawasaki disease. Methods: Two-hundred and sixty-two consecutive patients had been treated with a single dose of IVIG (2 g/kg) and aspirin (30 mg/kg per day). Thirty-five patients (13.4%) were not clinical responders to the initial IVIG treatment. They received an additional IVIG treatment (1 g/kg) within 48 h after the initial treatment. Seventeen patients (6.5%) did not respond to the additional IVIG treatment. We randomly divided these patients into two groups: group 1 consisted of eight patients who were treated with a single additional dose of IVIG (1 g/kg), while group 2 consisted of nine patients who were treated with steroid pulse therapy. Results: The IVIG-resistant patients had a high incidence of coronary artery lesions (CAL; 48.6%). Five patients (62.5%) in group 1 had CAL, including two patients who each had a giant aneurysm and three patients who each had a small aneurysm. Seven patients (77.8%) in group 2 had CAL, including two patients who each had a giant aneurysm, two patients who each had a small coronary aneurysm and three patients who each showed transient dilatation during steroid pulse therapy. There was no significant difference in the incidence of CAL between the two groups. The duration of high fever in group 2 (1.4 ± 0.7 days) was significantly shorter than in group 1 (4.8 ± 3.4 days; P <0.05). The medical costs for the treatment of patients in group 2 (¥113 012 ± 22 084) were significantly lower than those for group 1 (¥144 194 ± 12 914; P <0.05). Conclusions: Steroid pulse therapy may be useful in the treatment of patients with IVIG-resistant Kawasaki disease who experience prolonged fever. However, transient dilatation of the coronary artery is observed during steroid pulse therapy, so careful echocardiographic examination should be performed for those patients receiving steroid pulse therapy for the sake of early detection of coronary artery abnormalities.

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