Efficacy of Intravenous Immunoglobulin Combined with Prednisolone Following Resistance to Initial Intravenous Immunoglobulin Treatment of Acute Kawasaki Disease

Kobayashi, Toshimitsu; Kobayashi, T.; Morikawa, Akihiro; Ikeda, Kentaro; Seki, Mitsuru; Shimoyama, Shinya; Ishii, Yoichiro; Suzuki, Takahiro; Nakajima, Kimiko; Sakamoto, Naoko; Arakawa, Hirokazu

doi:10.1016/j.jpeds.2013.01.022

Cited by 78 publications

(60 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Again, the study was underpowered to show a significant difference between the groups. Teraguchi et al 228 212 reported a retrospective study to assess the efficacy of intravenous prednisolone followed by an oral taper (2 mg·kg −1 ·d −1 tapered over 2 weeks after CRP normalized) using a database of 359 consecutive IVIG-resistant patients. Patients treated with IVIG plus prednisolone had significantly lower rates of persistent or recrudescent fever and coronary artery abnormalities than the group that received IVIG monotherapy.…”

Section: 211mentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,738

4,124

View full text Add to dashboard Cite

BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

show abstract

Section: 211mentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

Self Cite

2,738

4,124

View full text Add to dashboard Cite

show abstract

“…As a result, a few scoring systems came into existence, i.e. Kobayashi, Sano, and Egami [7][8][9]. The scoring systems assess increased risk of unresponsiveness to IVIG treatment.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Berdej-Szczot¹,

Małecka-Tendera

Gawlik

et al. 2017

Kardiol Pol

View full text Add to dashboard Cite

A b s t r a c tBackground: The risk of immunoglobulin resistance is still likely to occur in Kawasaki disease (KD) despite adequate treatment. The Kobayashi score (KS) is used to predict unresponsiveness to treatment although the usefulness of the score in populations other than Asian seems to be debatable. Aim:The analysis of clinical and laboratory parameters predisposing to immunoglobulin resistance and coronary complications in children hospitalised due to KD. Methods:The data of children hospitalised due to KD between 2003 and 2016 underwent analysis. Clinical and laboratory parameters were analysed, including all parameters present in KS in relation to the risk of intravenous immunoglobulin (IVIG) resistance and the occurrence of coronary complications in the form of aneurysms and dilatations.Results: Seventy-three children (51 boys; aged 1.5-135 months) with KD were hospitalised. In eight (11%) patients IVIG resistance was observed. We reported aneurysms or coronary dilatations in 13 (17.8%) children. The criterion for increased risk of IVIG resistance based on KS (≥ 4 points) was fulfilled by 21 (29%) children. Resistance to IVIG and coronary complications were observed in four (19.1%) and two (9.5%) children with the score ≥ 4 points, respectively, and four (7.7%) and 11 (21.6%) from the group < 4 points in KS, respectively. The prevalence of IVIG resistance and coronary artery complications was not different between the group with ≥ 4 and the group with < 4 points (p = 0.22, p = 0.32, respectively). A higher risk of IVIG resistance was confirmed in children with a longer duration of fever (13.0 days with IVIG resistance vs. 9.2 days with a good response to IVIG, p = 0.04). For the prediction of the occurrence of coronary artery aneurysms the following were of great importance: the day of diagnosis (which was usually the day of the beginning of treatment), the number of symptoms, and the maximal platelet count (p = 0.001; p = 0.019 and p = 0.026, respectively). Conclusions:In our study population we did not demonstrate the usefulness of KS to predict IVIG resistance or the risk of the occurrence of coronary artery aneurysms. However, prolonged fever, late diagnosis, poorly symptomatic course of the disease, and a high platelet count at the time of the follow-up remain independent risk factors.

show abstract

“…As with IVMP, several retrospective studies re-evaluated prednisolone for its efficacy in reducing CAL. 16,17 In nonresponders to initial IVIg, 17 the incidence of CAL up to 1 month after treatment was lower in the IVIg plus prednisolone group (24/151, 16%) than in the IVIg group (39/136, 29%; P = 0.005) or the prednisolone group (22/72, 31%; P = 0.01).…”

Section: Re-evaluation and Current Status Of Glucocorticoid Therapymentioning

confidence: 98%

Role of glucocorticoids in Kawasaki disease

Miura

2017

Int J of Rheum Dis

View full text Add to dashboard Cite

Although treatment with intravenous immunoglobulin (IVIg) with aspirin is the standard of care for children with Kawasaki disease (KD), 15-20% of patients fail to respond and experience persistent or recurrent fever after completion of IVIg administration. These IVIg non-responders are at high risk for coronary artery lesions (CAL), and may need alternative or supplemental therapy. Based on retrospective studies (albeit with low evidence levels), glucocorticoid therapy was hitherto thought to worsen CAL. However, subsequent prospective studies have shown that prednisolone or IV methylprednisolone pulse as the initial or rescue therapy is effective in reducing CAL. A clinical trial known as the Randomized controlled trial to Assess Immunoglobulin plus Steroid Efficacy for KD (RAISE) Study, demonstrated the efficacy of prednisolone with initial IVIg, especially in predicted IVIg non-responders. Several meta-analyses have also supported the use of glucocorticoids for patients with severe forms of KD. Glucocorticoids can be considered as pre-emptive therapy for children with severe KD and as rescue therapy for initial non-responders. However, routine use of glucocorticoids in KD remains a contentious issue and would need further study.

show abstract

Efficacy of Intravenous Immunoglobulin Combined with Prednisolone Following Resistance to Initial Intravenous Immunoglobulin Treatment of Acute Kawasaki Disease

Cited by 78 publications

References 28 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Risk factors of immunoglobulin resistance and coronary complications in children with Kawasaki disease

Role of glucocorticoids in Kawasaki disease

Contact Info

Product

Resources

About