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. 2013 Aug;163(2):521-6.
doi: 10.1016/j.jpeds.2013.01.022. Epub 2013 Feb 26.

Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute Kawasaki disease

Tohru Kobayashi  1 , Tomio Kobayashi, Akihiro Morikawa, Kentaro Ikeda, Mitsuru Seki, Shinya Shimoyama, Yoichiro Ishii, Takahiro Suzuki, Kimiko Nakajima, Naoko Sakamoto, Hirokazu Arakawa
Affiliations

Efficacy of intravenous immunoglobulin combined with prednisolone following resistance to initial intravenous immunoglobulin treatment of acute Kawasaki disease

Tohru Kobayashi et al. J Pediatr. 2013 Aug.

Abstract

Objectives: 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).

Study design: 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.

Keywords: C-reactive protein; CAA; CRP; Coronary artery abnormality; IL; IVIG; Interleukin; Intravenous immunoglobulin; KD; Kawasaki disease; Methylprednisolone; mPSL.

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