Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease
Background:The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertainAim:To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-re...
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| Veröffentlicht in: | Archives of disease in childhood 2008-02, Vol.93 (2), p.142-146 |
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| creator | Furukawa, T Kishiro, M Akimoto, K Nagata, S Shimizu, T Yamashiro, Y |
| description | Background:The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertainAim:To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-resistant patients.Methods:IVMP was administered to patients with KD who had persistent or recurrent fever after a single dose of IVIG, at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.Results:411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.Conclusions:The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process. |
| doi_str_mv | 10.1136/adc.2007.126144 |
| format | Article |
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The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.Results:411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.Conclusions:The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/adc.2007.126144</identifier><identifier>PMID: 17962370</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><subject>Aneurysms ; Anti-Inflammatory Agents - administration & dosage ; Anti-Inflammatory Agents - adverse effects ; Anti-Inflammatory Agents - therapeutic use ; Aspirin ; Aspirin - therapeutic use ; Biological and medical sciences ; Care and treatment ; Child ; Child, Preschool ; Clinical Protocols ; Coronary Aneurysm - etiology ; Coronary Aneurysm - prevention & control ; Coronary vessels ; Demographic aspects ; Dosage and administration ; Drug Therapy, Combination ; Family (Sociological Unit) ; Female ; Fever ; General aspects ; Glucocorticoids - administration & dosage ; Glucocorticoids - adverse effects ; Glucocorticoids - therapeutic use ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous - therapeutic use ; Infant ; Intravenous immunoglobulins ; Kawasaki disease ; Kawasaki syndrome ; Male ; Medical sciences ; Methylprednisolone ; Methylprednisolone - administration & dosage ; Methylprednisolone - adverse effects ; Methylprednisolone - therapeutic use ; Miscellaneous ; Mucocutaneous Lymph Node Syndrome - complications ; Mucocutaneous Lymph Node Syndrome - drug therapy ; Patient outcomes ; Patients ; Persistence ; Platelet Aggregation Inhibitors - therapeutic use ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Pulse Therapy, Drug ; Research Committees ; Retrospective Studies ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Statistical Analysis ; Steroids ; Treatment Failure ; Treatment Outcome ; Veins & arteries</subject><ispartof>Archives of disease in childhood, 2008-02, Vol.93 (2), p.142-146</ispartof><rights>2008 BMJ Publishing Group and Royal College of Paediatrics and Child Health</rights><rights>2008 INIST-CNRS</rights><rights>Copyright: 2008 2008 BMJ Publishing Group and Royal College of Paediatrics and Child Health</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b530t-7e2ead3645e418bf673dd60aead2b9ab481602c87a67c81e6630be37510ba1613</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://adc.bmj.com/content/93/2/142.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://adc.bmj.com/content/93/2/142.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77342,77373</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19999018$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17962370$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Furukawa, T</creatorcontrib><creatorcontrib>Kishiro, M</creatorcontrib><creatorcontrib>Akimoto, K</creatorcontrib><creatorcontrib>Nagata, S</creatorcontrib><creatorcontrib>Shimizu, T</creatorcontrib><creatorcontrib>Yamashiro, Y</creatorcontrib><title>Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><description>Background:The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertainAim:To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-resistant patients.Methods:IVMP was administered to patients with KD who had persistent or recurrent fever after a single dose of IVIG, at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.Results:411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.Conclusions:The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.</description><subject>Aneurysms</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Anti-Inflammatory Agents - adverse effects</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Aspirin</subject><subject>Aspirin - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical Protocols</subject><subject>Coronary Aneurysm - etiology</subject><subject>Coronary Aneurysm - prevention & control</subject><subject>Coronary vessels</subject><subject>Demographic aspects</subject><subject>Dosage and administration</subject><subject>Drug Therapy, Combination</subject><subject>Family (Sociological Unit)</subject><subject>Female</subject><subject>Fever</subject><subject>General aspects</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Glucocorticoids - adverse effects</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Humans</subject><subject>Immunoglobulins</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Infant</subject><subject>Intravenous immunoglobulins</subject><subject>Kawasaki disease</subject><subject>Kawasaki syndrome</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methylprednisolone</subject><subject>Methylprednisolone - administration & dosage</subject><subject>Methylprednisolone - adverse effects</subject><subject>Methylprednisolone - therapeutic use</subject><subject>Miscellaneous</subject><subject>Mucocutaneous Lymph Node Syndrome - complications</subject><subject>Mucocutaneous Lymph Node Syndrome - drug therapy</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Persistence</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Pulse Therapy, Drug</subject><subject>Research Committees</subject><subject>Retrospective Studies</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Statistical Analysis</subject><subject>Steroids</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>0003-9888</issn><issn>1468-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkM9v0zAYQC0EYmVw5oYiIS5I6fwrtnOcqm0gBgMJuFqfnS8lXRIXOxHbf4-rVPSIL5bs99lPj5DXjK4ZE-oCGr_mlOo144pJ-YSsmFSm5FTKp2RFKRVlbYw5Iy9S2lHKuDHiOTljulZcaLoin6_aFv2UitAWacIYuqbYz33CYvqFEfaPRRiLbhjmMWz74Oa-G8uIqUsTjFPxCf5AgvuuaLqEkPAledZCHn513M_Jj-ur75sP5e3dzcfN5W3pKkGnUiNHaISSFUpmXKu0aBpFIR9yV4OThinKvdGgtDcMlRLUodAVow6YYuKcvF3e3cfwe8Y02V2Y45i_tMxww7WpKpGpcqG20KPtRh_GCR8mH_oet2iz0ebOXnJZ1UxqrTJ_sfA-hpQitnYfuwHio2XUHnLbnNsectsld554c_SY3YDNiT_2zcC7IwDJQ99GGH2XTlydF2XmpJrD4sO_e4j3NsfRlf3yc2O_Vdf8Rn-t7UH1_cK7Yfdfy79ik6Kt</recordid><startdate>20080201</startdate><enddate>20080201</enddate><creator>Furukawa, T</creator><creator>Kishiro, M</creator><creator>Akimoto, K</creator><creator>Nagata, S</creator><creator>Shimizu, T</creator><creator>Yamashiro, Y</creator><general>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</general><general>BMJ</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88B</scope><scope>88E</scope><scope>88I</scope><scope>8A4</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>CJNVE</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0P</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEDU</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>20080201</creationdate><title>Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease</title><author>Furukawa, T ; Kishiro, M ; Akimoto, K ; Nagata, S ; Shimizu, T ; Yamashiro, Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b530t-7e2ead3645e418bf673dd60aead2b9ab481602c87a67c81e6630be37510ba1613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aneurysms</topic><topic>Anti-Inflammatory Agents - administration & dosage</topic><topic>Anti-Inflammatory Agents - adverse effects</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Aspirin</topic><topic>Aspirin - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Care and treatment</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical Protocols</topic><topic>Coronary Aneurysm - etiology</topic><topic>Coronary Aneurysm - prevention & control</topic><topic>Coronary vessels</topic><topic>Demographic aspects</topic><topic>Dosage and administration</topic><topic>Drug Therapy, Combination</topic><topic>Family (Sociological Unit)</topic><topic>Female</topic><topic>Fever</topic><topic>General aspects</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Glucocorticoids - adverse effects</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Humans</topic><topic>Immunoglobulins</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Infant</topic><topic>Intravenous immunoglobulins</topic><topic>Kawasaki disease</topic><topic>Kawasaki syndrome</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Methylprednisolone</topic><topic>Methylprednisolone - administration & dosage</topic><topic>Methylprednisolone - adverse effects</topic><topic>Methylprednisolone - therapeutic use</topic><topic>Miscellaneous</topic><topic>Mucocutaneous Lymph Node Syndrome - complications</topic><topic>Mucocutaneous Lymph Node Syndrome - drug therapy</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Persistence</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Pulse Therapy, Drug</topic><topic>Research Committees</topic><topic>Retrospective Studies</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Statistical Analysis</topic><topic>Steroids</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Furukawa, T</creatorcontrib><creatorcontrib>Kishiro, M</creatorcontrib><creatorcontrib>Akimoto, K</creatorcontrib><creatorcontrib>Nagata, S</creatorcontrib><creatorcontrib>Shimizu, T</creatorcontrib><creatorcontrib>Yamashiro, Y</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>Education Periodicals</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Education Collection</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Education Database</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>Archives of disease in childhood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Furukawa, T</au><au>Kishiro, M</au><au>Akimoto, K</au><au>Nagata, S</au><au>Shimizu, T</au><au>Yamashiro, Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease</atitle><jtitle>Archives of disease in childhood</jtitle><addtitle>Arch Dis Child</addtitle><date>2008-02-01</date><risdate>2008</risdate><volume>93</volume><issue>2</issue><spage>142</spage><epage>146</epage><pages>142-146</pages><issn>0003-9888</issn><eissn>1468-2044</eissn><coden>ADCHAK</coden><abstract>Background:The use of intravenous immunoglobulin (IVIG) is well established as an initial therapy for Kawasaki disease (KD), but treatment for IVIG-resistant KD remains uncertainAim:To analyse the effects of intravenous methylprednisolone (IVMP) pulse therapy compared with additional IVIG in IVIG-resistant patients.Methods:IVMP was administered to patients with KD who had persistent or recurrent fever after a single dose of IVIG, at Juntendo University Hospital and affiliated medical institutions between May 2003 and March 2006. The effectiveness of the treatment and the incidence of coronary lesions in patients who received IVMP and those who received additional IVIG were retrospectively analysed and compared by chart review.Results:411 patients with KD were treated with a single dose of IVIG. Of the 63 IVIG-resistant patients, 44 were then given IVMP and 19 were given additional IVIG. Treatment was successful in 34 (77%) of the patients who received IVMP and 12 (63%) who received additional IVIG. Five of the 10 patients who did not respond to IVMP and two of the seven who did not respond to additional IVIG developed coronary artery aneurysms. Although fever initially resolved faster in the IVMP-resistant group, there was a delay in fever recurrence, which ultimately delayed the final resolution of fever.Conclusions:The findings suggest that IVMP is an effective additional treatment for IVIG-resistant KD. However, there was a tendency for fever to recur later in IVMP-resistant patients, which could potentially delay the therapeutic decision-making process.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</pub><pmid>17962370</pmid><doi>10.1136/adc.2007.126144</doi><tpages>5</tpages></addata></record> |
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| ispartof | Archives of disease in childhood, 2008-02, Vol.93 (2), p.142-146 |
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| subjects | Aneurysms Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - adverse effects Anti-Inflammatory Agents - therapeutic use Aspirin Aspirin - therapeutic use Biological and medical sciences Care and treatment Child Child, Preschool Clinical Protocols Coronary Aneurysm - etiology Coronary Aneurysm - prevention & control Coronary vessels Demographic aspects Dosage and administration Drug Therapy, Combination Family (Sociological Unit) Female Fever General aspects Glucocorticoids - administration & dosage Glucocorticoids - adverse effects Glucocorticoids - therapeutic use Humans Immunoglobulins Immunoglobulins, Intravenous - therapeutic use Infant Intravenous immunoglobulins Kawasaki disease Kawasaki syndrome Male Medical sciences Methylprednisolone Methylprednisolone - administration & dosage Methylprednisolone - adverse effects Methylprednisolone - therapeutic use Miscellaneous Mucocutaneous Lymph Node Syndrome - complications Mucocutaneous Lymph Node Syndrome - drug therapy Patient outcomes Patients Persistence Platelet Aggregation Inhibitors - therapeutic use Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Pulse Therapy, Drug Research Committees Retrospective Studies Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Statistical Analysis Steroids Treatment Failure Treatment Outcome Veins & arteries |
| title | Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease |
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