RT Journal Article SR Electronic T1 Corticosteroid Pulse Combination Therapy for Refractory Kawasaki Disease: A Randomized Trial JF Pediatrics JO Pediatrics FD American Academy of Pediatrics SP e17 OP e23 DO 10.1542/peds.2011-0148 VO 129 IS 1 A1 Ogata, Shohei A1 Ogihara, Yoshihito A1 Honda, Takashi A1 Kon, Shinya A1 Akiyama, Kazumasa A1 Ishii, Masahiro YR 2012 UL http://pediatrics.aappublications.org/content/129/1/e17.abstract AB 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.Abbreviations:ALT — alanine aminotransferaseASA — acetylsalicylic acidAST — aspartate aminotransferase, CAL, coronary artery lesionCRP — C-reactive proteinIQR — interquartile rangeIVIG — intravenous immunoglobulinIVMP — intravenous methylprednisolone-pulseKD — Kawasaki diseaseLAD — proximal left anterior descending coronary arteryLMT — left main trunk coronary arteryRCA — right coronary artery