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. 2020 Nov 24:2020:4175821.
doi: 10.1155/2020/4175821. eCollection 2020.

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

Zhouping Wang #  1 , Feiyan Chen #  2 , Yanfei Wang  1 , Wei Li  1 , Xiaofei Xie  1 , Peiying Liu  1 , Xu Zhang  1 , Li Zhang  1 , Ping Huang  1
Affiliations

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

Zhouping Wang et al. J Immunol Res. .

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.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
Protocol and results of the treatment in this study. IVIG: intravenous immunoglobulin; CAL: coronary arterial lesion; MPT: methylprednisolone pulse therapy; OM: oral methylprednisolone.
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