Abstract 12601: Efficacy of Intravenous Immunoglobulin Combined With Prednisolone for Resistance to Initial Immunoglobulin Treatment of Acute Kawasaki Disease
Background: Efficacy of prednisolone for Kawasaki disease (KD) patients who fail to respond to initial intravenous immunoglobulin (IVIG) is unclear.
Methods and Results: We reviewed clinical records of 375 consecutive KD patients who failed to respond to initial IVIG. IVIG alone (141 patients), prednisolone (PSL) alone (80 patients), or IVIG+PSL (154 patients) were treated as first line rescue therapy. Incidence of fail to respond to first line rescue therapy was less frequent in the IVIG+PSL group (12.3%) than those in the IVIG group 38.3%, P<0.001) and the PSL group (30.0%, P=0.005). Incidence of coronary artery abnormalities (CAA) until 1 month was less frequent in the IVIG+PSL group (15.6%) than those in the IVIG group (29.8%, P=0.004) and the PSL group (30.0%, P=0.008). The IVIG+PSL group was significantly lower risk of fail to respond to first line rescue therapy (adjusted odds ratio (OR) 0.16; 95% confidence interval (CI), 0.09-0.31), CAA until 1 month (adjusted OR 0.45; 95% CI, 0.25-0.81), and CAA at 1 month (adjusted OR 0.39; 95% CI, 0.17-0.88) compared with the IVIG group. Among the PSL and IVIG+PSL group, risk score point (OR 1.30, 95% CI 1.04-1.62), illness day of first line rescue therapy (OR 1.25, 95% CI 1.01-1.54), PSL mono-therapy (OR 3.00, 95% CI 1.16-7.79) and resistance to the first line rescue therapy (OR 2.85, 95% CI 1.04-7.78) was independent risk factor of coronary artery abnormalities formation.
Conclusions: IVIG+PSL may be useful in the treatment of KD patients with fail to respond to initial IVIG.
- © 2012 by American Heart Association, Inc.