European Journal of Pediatrics

, Volume 168, Issue 2, pp 181–185

Pulse methylprednisolone with gammaglobulin as an initial treatment for acute Kawasaki disease

Authors

    • Department of Pediatric Hematology/OncologyOsaka City General Hospital
  • Junichi Hara
    • Department of Pediatric Hematology/OncologyOsaka City General Hospital
  • Ichiro Maki
    • Ikeda Municipal Hospital
  • Kazunori Miki
    • Itami Municipal Hospital
  • Kouji Matsuzaki
    • Suita Municipal Hospital
  • Taro Matsuoka
    • Toyonaka Municipal Hospital
  • Takehisa Yamamoto
    • Mino City Hospital
  • Toshinori Nishigaki
    • Osaka Keisatsu Hospital
  • Syunji Kurotobi
    • Osaka University Graduate School of Medicine
  • Tetsuya Sano
    • Osaka Kosei-nenkin Hospital
  • For the Osaka Kawasaki Disease Study Group
Original Paper

DOI: 10.1007/s00431-008-0727-9

Cite this article as:
Okada, K., Hara, J., Maki, I. et al. Eur J Pediatr (2009) 168: 181. doi:10.1007/s00431-008-0727-9

Abstract

Approximately 15–20% of patients with Kawasaki disease (KD) are not responsive to high-dose intravenous gammaglobulin (IVIG). We have previously reported a predictive method for identifying IVIG-non-responsive patients (high-risk KD patients). We determined the safety and effectiveness of pulse methylprednisolone with high-dose IVIG (mPSL+IVIG) as a primary treatment for high-risk KD patients. Sixty-two high-risk KD patients were treated with pulse methylprednisolone 30 mg/kg over 2 h, followed by IVIG 2 g/kg over 24 h (mPSL+IVIG group) and were compared with a historical control group of 32 high-risk patients treated with IVIG 2 g/kg alone at the participating hospitals before this study was opened (IVIG group). High-risk patients were identified with at least two of three predictors (C-reactive protein ≥7 mg/dL, total bilirubin ≥0.9 mg/dL or aspartate aminotransferase ≥200 IU/L). Sixty-six percent (95% confidence interval [CI] 54–78%) of patients had a prompt defervescence in the mPSL+IVIG group compared with 44% (95% CI 26–62%) for the IVIG group (p = 0.048). Coronary artery lesions were observed in 24.2% (95% CI 13.2–35.2%) and 46.9% (95% CI 28.6–65.2%) of patients in the mPSL+IVIG and IVIG groups, respectively (p = 0.025). This is the first report showing that mPSL+IVIG is effective and safe as a primary treatment for high-risk KD patients.

Keywords

Kawasaki diseaseMethylprednisoloneCoronary disease

Abbreviations

IVIG

Intravenous gammaglobulin

KD

Kawasaki disease

mPSL

Methylprednisolone

Copyright information

© Springer-Verlag 2008