Methylprednisolone Pulse Therapy or Additional IVIG for Patients with IVIG-Resistant Kawasaki Disease.

Zhouping Wang,Yanfei Wang,Xu Zhang,Peiying Liu,Ping Huang,Li Zhang,Feiyan Chen,Wei Li,Xiaofei Xie,Peirong Jiao

doi:10.1155/2020/4175821

Abstract

There have been no robust data from clinical trials to guide the clinician in the choice of therapeutic agents for the child with intravenous immunoglobulin (IVIG) resistance. The treatment regimen for IVIG-resistant patients varies between institutions, and the best option has not yet been established. Therefore, in this trial, a total of 955 patients with Kawasaki disease (KD) were selected and were initially treated with IVIG (2 g/kg), of whom 80 (8.38%) assessed as IVIG resistant were randomly divided into two groups: Group A received the second IVIG treatment (n = 40), and Group B received methylprednisolone pulse therapy (MPT, n = 40). The whole fever time, duration of fever after retreatment, hospital days, medical costs, readmission rate, and laboratory examination difference (△) were calculated. Coronary artery lesion (CAL) outcomes were followed up over two years. Patients in the MPT group had shorter fever after retreatment and lower medical costs; more rapid declines in C-reactive protein (CRP), neutrophils (N%), and platelet (PLT) levels; and more rapid rise in sodium. However, they also probably had a higher incidence of treatment failure and CALs than the additional IVIG treatment group in the long-term follow-up. Caution is still required in the use of MPT to treat IVIG-resistant KD.

Highlights

Kawasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children < 5 years of age [1]
A total of 955 patients with KD at the Department of Cardiology of Guangzhou Women and Children’s Medical Center from January 2018 to June 2019 were selected and initially treated with intravenous immunoglobulin (IVIG). 80 patients who were assessed as IVIG resistant were randomly divided into two groups using a random number table
We administered third-line therapy to those who did not respond to the second-line treatment: eight of the eleven patients who were readmitted to hospital received oral methylprednisolone (2 mg/kg/d), and three received IVIG (2 g/kg)

Summary

Introduction

KD is an acute, self-limited febrile illness of unknown cause that predominantly affects children < 5 years of age [1]. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries [2]. IVIG retreatment for IVIG-resistant KD is far from an established therapy. Several retrospective studies suggest that MPT for IVIG-resistant KD may reduce the risk for CALs [11, 12].

Methods

Results

Conclusion