Mitsuaki Kimura1, Masashi Harazaki2, Tetsuya Fukuoka3, Isao Asakura4, Hidemasa Sakai5, Tsutomu Kamimaki6, Ichiro Ohkawara7, Naoe Akiyama8, Satoshi Tsurui9, Satoru Iwashima10, Masaki Shimomura1, Hideaki Morishita1, Takaaki Meguro1, Shiro Seto1. 1. Department of Allergy and Clinical Immunology, Shizuoka Children's Hospital, Shizuoka, Japan. 2. Department of Pediatrics, Shizuoka General Hospital, Shizuoka, Japan. 3. Department of Pediatrics, Shizuoka Saiseikai General Hospital, Shizuoka, Japan. 4. Department of Pediatrics, Fujieda Municipal General Hospital, Shizuoka, Japan. 5. Department of Pediatrics, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 6. Department of Pediatrics, Shizuoka City Shimizu Hospital, Shizuoka, Japan. 7. Department of Pediatrics, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan. 8. Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan. 9. Department of Pediatrics, Seirei Numazu Hospital, Shizuoka, Japan. 10. Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Abstract
BACKGROUND: Prednisolone (PSL) has been suggested to be useful for the treatment of Kawasaki disease (KD) resistant to i.v. immunoglobulin (IVIG), but much remains to be elucidated regarding its use. METHODS: A total of 1087 subjects were involved in a two-study multicenter prospective investigation of the effects of acute phase therapy on IVIG-resistant KD. Subjects resistant to the first dose of IVIG were classified into high (≥10 mg/dL) and low (<10 mg/dL) serum C-reactive protein (CRP) groups after the first dose of IVIG. RESULTS: In the first study, the efficacy of the second dose of IVIG in the high CRP group was significantly lower than in the low CRP group (47.8% vs 76.8%, P < 0.005). In the second study, PSL was co-administered with the second dose of IVIG to the high CRP patients (intensified regimen). The efficacy of the intensified regimen was similar to that of the second dose of IVIG in the low CRP group (79.4% vs 83.3%). Although the difference in the incidence of persistent coronary artery lesions (CAL) between the high and low CRP groups was significant in the first study (19.6% vs 3.0%, P < 0.005), it was not significant in the second study (8.8% vs 2.4%). CONCLUSIONS: The targeted use of PSL with the second dose of IVIG in KD patients resistant to the first dose of IVIG and who are predicted to be resistant to the second dose of IVIG, appears to be effective.
BACKGROUND:Prednisolone (PSL) has been suggested to be useful for the treatment of Kawasaki disease (KD) resistant to i.v. immunoglobulin (IVIG), but much remains to be elucidated regarding its use. METHODS: A total of 1087 subjects were involved in a two-study multicenter prospective investigation of the effects of acute phase therapy on IVIG-resistant KD. Subjects resistant to the first dose of IVIG were classified into high (≥10 mg/dL) and low (<10 mg/dL) serum C-reactive protein (CRP) groups after the first dose of IVIG. RESULTS: In the first study, the efficacy of the second dose of IVIG in the high CRP group was significantly lower than in the low CRP group (47.8% vs 76.8%, P < 0.005). In the second study, PSL was co-administered with the second dose of IVIG to the high CRPpatients (intensified regimen). The efficacy of the intensified regimen was similar to that of the second dose of IVIG in the low CRP group (79.4% vs 83.3%). Although the difference in the incidence of persistent coronary artery lesions (CAL) between the high and low CRP groups was significant in the first study (19.6% vs 3.0%, P < 0.005), it was not significant in the second study (8.8% vs 2.4%). CONCLUSIONS: The targeted use of PSL with the second dose of IVIG in KDpatients resistant to the first dose of IVIG and who are predicted to be resistant to the second dose of IVIG, appears to be effective.