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Combined treatment appears effective for patients with Kawasaki disease
Ogata S. Pediatrics. 2011;doi:10.1542/peds.2011-0148.
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Combining intravenous methylprednisolone pulse and intravenous immunoglobulin to treat patients with Kawasaki disease appears safe and effective, according to data published online this week.
Shohei Ogata, MD, and colleagues from Kitasato University School of Medicine in Japan looked at data on 122 patients with Kawasaki disease who were randomly assigned to either the combined treatment or IV immunoglobulin (IVIG) alone.
Ogata and colleagues said fever abated more quickly in 19 of 22 patients in the combined group when compared with six of the 26 patients in the IVIG group.
The researchers also said coronary artery dimension z scores of 2.5 or more at 1 month were higher in the IVIG group than in the combined treatment group.
Regarding adverse events, the researchers said the combination therapy led to hypothermia, bradycardia and hypertension in some patients; however, “these adverse events were transient, and no serious adverse events were observed” in either group.
The researchers noted some study limitations; specifically that it was not a blind or multicenter study, which they said will be necessary to confirm the safety of the treatment.
“Approximately 15% to 20% of patients with [Kawasaki disease] are not responsive to initial IVIG treatment, and these patients are at a higher risk for coronary artery lesions,” the researchers wrote. “It is important to identify these patients because they might benefit from more aggressive initial treatment.”
Disclosure: The researchers report no relevant financial disclosures.
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There are a paucity of controlled data related to treatment of Kawasaki disease that is refractory to IVIG. Ogata and colleagues utilized a clinical score to select Japanese Kawasaki disease patients predicted to be more likely refractory to standard therapy. Unfortunately, this scoring system has been a less useful predictor in non-Japanese patients. Addition of one pulse 30 mg/kg dose of methylprednisolone in selected patients (with 26 hours of IV heparin) to IV Ig and aspirin as primary therapy led to less fever and more rapid normalization of inflammatory markers, with small reductions in some coronary dimensions 36 hours and 1 month after treatment compared with non-steroid recipients. A higher rate of adverse events (hypothermia, bradycardia, hypertension) occurred in steroid recipients. The authors correctly conclude that a double blind, placebo-controlled study is needed to confirm safety and efficiency of this regimen. Its applicability to non-Japanese patients is unclear.
–Stanford T. Shulman, MD
Infectious
Diseases in Children Editorial Board
Disclosure: Dr. Shulman reports no relevant financial disclosures.
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