Methylprednisolone pulse therapy or additional IVIG for patients with
IVIG resistant Kawasaki disease
Abstract
There are no robust data from clinical trials to guide the clinician in
the choice of therapeutic agents for the child with intravenous
immunoglobulin (IVIG) resistance. Moreover, the treatment regimen for
IVIG-resistant patients varies between institutions, and the best option
has not yet been established. Therefore, in this trial, 955 patients
with Kawasaki disease (KD) were selected and were initially treated with
IVIG (2 g/kg), of these patients, 80 (8.38%) assessed as IVIG resistant
were randomly divided into two groups: Group A (n = 40) received a
second IVIG treatment, and Group B (n = 40) received methylprednisolone
pulse therapy (MPT). Duration of fever, duration of fever after
retreatment, hospital days, medical costs, readmission rate, and
laboratory examination difference (△) were calculated. Coronary artery
lesions (CALs) outcomes were followed up over two years. Patients in MPT
group had a shorter fever after retreatment and lower medical costs;
more rapid decline in C-reactive protein (CRP), Neutrophils% (N%),
platelets (PLT) levels; and a more rapid rise in sodium. However, they
also had a higher incidence of treatment failure and CALs than the
additional IVIG treatment group in the long-term follow-up. Caution is
still required in the use of MPT to treat IVIG-resistant KD.