Immunoglobulin Failure and Retreatment in Kawasaki Disease

Durongpisitkul, Kritvikrom; Soongswang, Jarupim; Laohaprasitiporn, Duangmanee; Nana, Arth; Prachuabmoh, Chadsri; Kangkagate, Charuwan

doi:10.1007/s00246-002-0216-2

Cited by 171 publications

(160 citation statements)

References 11 publications

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“…We found no difference in the incidence of rKD with regard to gender, age, or ethnicity. Some of these fi ndings are in accordance with results of studies by Do et al, 14 Cha et al, 15 and Durongpisitkul et al, 16 who have reported similar age and gender distribution between rKD and sKD in Korea and Thailand. Our results contrast with other studies that have found younger age to be a predictor for rKD.…”

Section: Discussionsupporting

confidence: 91%

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Ghelani

Pastor²,

Parikh³

2012

Hospital Pediatrics

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Objective: Approximately 10% to 15% of Kawasaki disease (KD) is refractory to treatment with initial intravenous immunoglobulin (IVIG). However, there is no consensus on pharmacologic treatment of refractory KD (rKD). Demographic characteristics of patients with rKD and regional variability in their treatment in the United States have not been reported on a large scale. The goal of this study was to describe the demographic and treatment variability in rKD by using a large multi-institutional database. Methods: Data were obtained for patients with KD from January 2005 to June 2009 by using the Pediatric Health Information System. Patients who received a single dose of IVIG were labeled as having standard KD (sKD) and those who required additional medications were labeled as having rKD. Results: Of the 5633 patients studied, 4818 (85.5%) received 1 dose of IVIG (sKD) and 815 (14.5%) received >1 medication (rKD). Median age was 30 months (interquartile range: 14-53) and 30 months (interquartile range: 15-54) for rKD and sKD patients, respectively (P= .438). No significant change was noted in the gender or ethnic distribution of patients between rKD and sKD groups. Seasonal distribution of rKD was comparable to sKD. IVIG was the most common (64.5%) initial medication chosen to treat rKD, followed by methylprednisolone (27.1%) and infliximab (8.3%); however, there was significant regional variability. Of patients with rKD, 81% required only 1 additional medication (after the initial IVIG) for treatment. Conclusions: Patients with rKD have similar age, gender, ethnic, and seasonal distribution as sKD patients. IVIG is the most common initial medication chosen to treat rKD; however, there is regional variation.

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Section: Discussionsupporting

confidence: 91%

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Ghelani

Pastor²,

Parikh³

2012

Hospital Pediatrics

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“…Multiple scoring systems for predicting IVIG-resistance in patients with KD have been published from other countries (2,(12)(13)(14). However, the only scoring system for which we had all of the variables in our database was published by Egami et al from Japan (12).…”

Section: Resultsmentioning

confidence: 99%

“…Treatment with a single dose of intravenous immunoglobulin (IVIG) and high-dose aspirin results in resolution of fever in most patients and significantly reduces the rate of coronary artery aneurysms (1). Despite this success, 10-20% of children will have persistent or recrudescent fever after their first infusion of IVIG (2)(3)(4)(5). These patients are at increased risk of developing coronary artery abnormalities (5,6).…”

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confidence: 99%

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Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

Tremoulet

Best

Song

et al. 2008

The Journal of Pediatrics

356

295

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Objectives-To explore the increased incidence of intravenous immunoglobulin (IVIG) resistance among San Diego County Kawasaki disease (KD) patients in 2006 and to evaluate a scoring system to predict IVIG-resistant patients with KD.Study design-We performed a retrospective review of patients with KD treated within 10 days of fever onset. Using multivariate analysis, independent predictors of IVIG-resistance were combined into a scoring system. 2006, 38.3 % of patients with KD in San Diego County were IVIG-resistant, a significant increase over previous years. IVIG-resistance was not associated with a particular brand or lot of IVIG. Resistant patients were diagnosed earlier, had higher % bands, and higher concentrations of C-reactive protein, alanine aminotransferase, and γ-glutamyl transferase (GGT). They also had lower platelet counts and age-adjusted hemoglobin (zHgb) concentrations and were more likely to have aneurysms (p=0.0008). A scoring system developed to predict IVIG-resistant patients using illness day, % bands, GGT, and zHgb, had a sensitivity of 73.3% and specificity of 61.9%. Results-InConclusions-An unexplained increase in IVIG-resistance was noted among patients with KD in San Diego County in 2006. Scoring systems based on demographic and laboratory data were insufficiently accurate to be clinically useful in our ethnically diverse population. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Keywords Conflict of Interests:The authors have no conflicts of interest to report. Kawasaki disease (KD), the leading cause of pediatric acquired heart disease in the United States and Japan, is an acute, systemic vasculitis. Treatment with a single dose of intravenous immunoglobulin (IVIG) and high-dose aspirin results in resolution of fever in most patients and significantly reduces the rate of coronary artery aneurysms (1). Despite this success, 10-20% of children will have persistent or recrudescent fever after their first infusion of IVIG (2-5). These patients are at increased risk of developing coronary artery abnormalities (5,6). Additional therapies used in these patients include retreatment with IVIG, immunomodulatory agents such as infliximab, high dose methylprednisolone, cyclophosphamide, and plasmapheresis. (7-11). Identification of patients who are likely to be IVIG-resistant would allow the use of additional therapies early in the course of their illness when prevention of coronary artery damage might still be possible. NIH Public AccessA number of recent studies from Asia have identified demographic and laboratory characteristics, including age...

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“…156,167,168 Failure to respond usually is defined as persistent or recrudescent fever Ն36 hours after completion of the initial IVIG infusion. Most experts recommend retreatment with IVIG, 2 g/kg (evidence level C).…”

Section: Ivigmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

1,604

818

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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Immunoglobulin Failure and Retreatment in Kawasaki Disease

Cited by 171 publications

References 11 publications

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Demographic and Treatment Variability of Refractory Kawasaki Disease: A Multicenter Analysis From 2005 to 2009

Resistance to Intravenous Immunoglobulin in Children with Kawasaki Disease

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

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