European Journal of Pediatrics

, Volume 168, Issue 2, pp 181–185

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

  • Keiko Okada
  • Junichi Hara
  • Ichiro Maki
  • Kazunori Miki
  • Kouji Matsuzaki
  • Taro Matsuoka
  • Takehisa Yamamoto
  • Toshinori Nishigaki
  • Syunji Kurotobi
  • Tetsuya Sano
  • 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

Authors and Affiliations

  • Keiko Okada
    • 1
  • Junichi Hara
    • 1
  • Ichiro Maki
    • 2
  • Kazunori Miki
    • 3
  • Kouji Matsuzaki
    • 4
  • Taro Matsuoka
    • 5
  • Takehisa Yamamoto
    • 6
  • Toshinori Nishigaki
    • 7
  • Syunji Kurotobi
    • 8
  • Tetsuya Sano
    • 9
  • For the Osaka Kawasaki Disease Study Group
  1. 1.Department of Pediatric Hematology/OncologyOsaka City General HospitalMiyakojima-ku, OsakaJapan
  2. 2.Ikeda Municipal HospitalOsakaJapan
  3. 3.Itami Municipal HospitalHyogoJapan
  4. 4.Suita Municipal HospitalOsakaJapan
  5. 5.Toyonaka Municipal HospitalOsakaJapan
  6. 6.Mino City HospitalOsakaJapan
  7. 7.Osaka Keisatsu HospitalOsakaJapan
  8. 8.Osaka University Graduate School of MedicineOsakaJapan
  9. 9.Osaka Kosei-nenkin HospitalOsakaJapan