European Journal of Pediatrics

, Volume 167, Issue 10, pp 1119–1123 | Cite as

Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin

  • Masaru Miura
  • Kazuki Kohno
  • Hirotaka Ohki
  • Shigeki Yoshiba
  • Akinori Sugaya
  • Masaaki Satoh
Original Paper

Abstract

This study aimed to determine the effects of intravenous methylprednisolone pulse (IVMP) therapy on cytokine levels in patients with acute Kawasaki disease (KD) unresponsive to initial intravenous immunoglobulin (IVIG) therapy. Fifteen KD patients unresponsive to initial IVIG, 2 g/kg/day, were randomized to receive IVMP (n = 7), 30 mg/kg/day for 3 days or additional IVIG (n = 8), 2 g/kg/day, and plasma cytokine levels were compared. The fraction of febrile patients was significantly lower in the IVMP group than in the additional IVIG group on day 2 (0/7 vs. 3/8, p = 0.03), but not on day 4 and later (3/7 vs. 4/8, p = 1.00) because of recurrent fever. The prevalence of coronary lesions was similar between the two groups (2/7 vs. 2/8, p = 1.00). The ratios of plasma levels of tumor necrosis factor-α and monocyte chemoattractant protein-1 to those at enrollment (defined as day 1) were significantly lower in the IVMP group on day 4 (0.50 ± 0.27 vs. 1.01 ± 0.46, 0.53 ± 0.39 vs. 0.93 ± 0.44, p = 0.02 and 0.045, respectively), but not on day 7 (0.54 ± 0.34 vs. 0.88 ± 0.39, 0.76 ± 0.39 vs. 0.61 ± 0.17, p = 0.07 and 0.83, respectively). The ratios of interleukin-2 receptor, interleukin-6, and vascular endothelial cell growth factor to those at enrollment did not differ significantly between the two groups. In conclusion, for KD patients unresponsive to initial IVIG, IVMP suppresses cytokine levels faster, but subsequently similarly, compared with additional IVIG.

Keywords

Cytokine Kawasaki disease Steroid pulse 

Abbreviations

IVIG

Intravenous immunoglobulin

IVMP

Intravenous methylprednisolone pulse

IL-6

Interleukin-6

KD

Kawasaki disease

MCP-1

Monocyte chemoattractant protein-1

sIL-2R

Soluble interleukin-2 receptor

TNF-α

Tumor necrosis factor-α

VEGF

Vascular endothelial cell growth factor

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Masaru Miura
    • 1
    • 2
  • Kazuki Kohno
    • 1
  • Hirotaka Ohki
    • 1
  • Shigeki Yoshiba
    • 1
  • Akinori Sugaya
    • 1
  • Masaaki Satoh
    • 1
  1. 1.Department of CardiologyTokyo Metropolitan Kiyose Children’s HospitalTokyoJapan
  2. 2.Kiyose, TokyoJapan

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