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Abstract
Objective: This study examined the clinical efficacy and safety of intravenous methylprednisolone-pulse plus intravenous immunoglobulin (IVIG) combination therapy (IVMP+IVIG) for the initial treatment of patients predicted to have refractory Kawasaki disease (KD).
Methods: One hundred twenty-two patients with KD were studied at Kitasato University. Refractory KD was predicted at diagnosis using the Egami score, and the patients were randomly divided to receive either IVMP+IVIG or IVIG alone. The Egami score is used to predict refractory KD patients before treatment using the patient’s age, days of illness, platelet count, C-reactive protein, and alanine aminotransferase level (cutoff: ≥3 points; 78% sensitivity and 76% specificity).
Results: Forty-eight patients (39.3%) were predicted to have refractory KD on the basis of the Egami score. The predicted IVIG responders (n = 74) received the standard therapy. The 48 predicted refractory KD patients were randomly assigned to a single-IVIG group (n = 26) or an IVMP+IVIG group (n = 22). Nineteen of the 22 patients (86.4%) in the IVMP+IVIG group had a prompt defervescence compared with 6 of the 26 patients (23.1%) in the single-IVIG group. The number of patients who had a z score ≥2.5 at 1 month was significantly higher in the single-IVIG group than in the IVMP+IVIG group. No serious adverse events were observed in either treatment group.
Conclusions: This study demonstrated that IVMP+IVIG therapy is safe and effective for KD patients predicted as refractory.
- ALT —
- alanine aminotransferase
- ASA —
- acetylsalicylic acid
- AST —
- aspartate aminotransferase, CAL, coronary artery lesion
- CRP —
- C-reactive protein
- IQR —
- interquartile range
- IVIG —
- intravenous immunoglobulin
- IVMP —
- intravenous methylprednisolone-pulse
- KD —
- Kawasaki disease
- LAD —
- proximal left anterior descending coronary artery
- LMT —
- left main trunk coronary artery
- RCA —
- right coronary artery
- Accepted September 9, 2011.
- Copyright © 2012 by the American Academy of Pediatrics
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