scholarly journals Corticosteroids Added to Initial Intravenous Immunoglobulin Treatment for the Prevention of Coronary Artery Abnormalities in High‐Risk Patients With Kawasaki Disease

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Ryusuke Ae ◽  
Joseph Y. Abrams ◽  
Ryan A. Maddox ◽  
Lawrence B. Schonberger ◽  
Yosikazu Nakamura ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Treatment Group ◽  
High Risk ◽  
Kawasaki Disease ◽  
Treatment Failure ◽  
Intravenous Immunoglobulin ◽  
Combination Treatment ◽  
Coronary Artery Abnormalities ◽  
Estimated Risk ◽  
Immunoglobulin Treatment

BACKGROUND Randomized controlled trials previously provided different conclusions about the superiority of adding corticosteroids to initial intravenous immunoglobulin treatment for the prevention of coronary artery abnormalities in patients with Kawasaki disease (KD). To further assess this issue, we analyzed large‐scale data from nationwide KD surveys in Japan, where combination treatment (corticosteroids added to initial standard intravenous immunoglobulin treatment) has become commonly used for patients at high risk for KD. METHODS AND RESULTS Standard intravenous immunoglobulin treatment and combination treatment were compared using data from time periods with and without combination treatment. Outcome measures were coronary artery abnormalities and initial intravenous immunoglobulin treatment failure. Hospitals where ≥20% of patients received combination treatment were identified, and treatment and control groups were selected via matching by age, sex, illness day at initial treatment, and KD recurrence. Matched group selection and subsequent analyses were conducted 1000 times to minimize sampling bias and potential confounders (bootstrapping). From 115 hospitals, 1593 patients with KD in the treatment group and 1593 controls were selected for each of the 1000 sample iterations. The median proportion of patients who developed coronary artery abnormalities among the treatment group and controls were 4.6% (95% CI, 3.8%–5.8%) and 8.8% (95% CI, 7.5%–10.0%), respectively: an estimated risk ratio of 0.53 (0.41–0.67). A median of 14.1% (95% CI, 12.4%–15.9%) of the patients in the treatment group and 21.7% (95% CI, 19.8%–23.4%) in the controls had treatment failure: an estimated risk ratio of 0.65 (0.56―0.75). CONCLUSIONS Combination treatment reduced coronary artery abnormality risk by an estimated 47% and treatment failure by 35%. Multiple‐dose corticosteroids may provide benefit in selected patients at high risk for KD.

scholarly journals High risk of coronary artery aneurysm in Kawasaki disease

Rheumatology ◽  
2020 ◽  
Author(s):  
Maria Mossberg ◽  
Aladdin J Mohammad ◽  
Fredrik Kahn ◽  
Mårten Segelmark ◽  
Robin Kahn
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Demographic Data ◽  
Artery Aneurysm ◽  
Heart Association ◽  
Coronary Aneurysms ◽  
Immunoglobulin Treatment ◽  
Timely Treatment

Abstract Objective Kawasaki disease (KD) is a vasculitis of unknown aetiology with a high risk of coronary aneurysms if untreated. Timely treatment with intravenous immunoglobulin decreases the risk for coronary artery aneurysms (CAA). In this study, we set out to elucidate the factors associated with the risk of developing CAA. Methods Records of all KD-diagnosed children in Skåne between 2004 and 2014 were collected and clinical and demographic data were compiled. KD is defined according to the revised American Heart Association diagnostic criteria and classified as either complete KD (cKD) or incomplete KD (iKD). Results KD was diagnosed in 77 children and CAA was found in 31% (n = 24). Children with CAA were younger compared with children without (median; 20 vs 34 months) and intravenous immunoglobulin treatment within 10 days was less likely to be received (75% vs 91%). In children presenting with iKD, 47% developed CAA compared with 21% in cKD patients. Using multivariate analysis, an association between the risk of CAA with low age in children with iKD was observed. Conclusion The risk of CAA development is disturbingly high in young children with iKD. This highlights the importance of rapid intense treatment and vigilance in infants, who are the most difficult to diagnose, in order to reduce the frequency of CAA.

Stratified therapy for Kawasaki disease using a new scoring system to predict the response to a lower dose of intravenous immunoglobulin therapy

2021 ◽  
pp. 1-5
Author(s):  
Misa Matsuura ◽  
Daisuke Sugawara ◽  
Eishi Makita ◽  
Yuka Hirakubo ◽  
Kazuhito Nonaka ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Risk Score ◽  
Risk Group ◽  
Immunoglobulin Therapy ◽  
Low Risk ◽  
Immunoglobulin Treatment ◽  
New Scoring

Abstract Background: Several studies have reported treatment options for patients with Kawasaki disease refractory to standard immunoglobulin therapy; however, no studies have reported low-dose immunoglobulin therapy for patients with a low risk of Kawasaki disease. Methods: A total of 277 patients with Kawasaki disease were included in this study. We used Kobayashi score and our Less high-risk score to divide the patients into three groups. Patients in the high-risk group (Kobayashi score ≥ 5 points) received 2 g/kg intravenous immunoglobulin and prednisolone. Patients in the moderate-risk group (Kobayashi score < 5 points and Less high-risk score ≥ 2 points) received 2 g/kg intravenous immunoglobulin treatment. Patients in the low-risk group (Kobayashi score < 5 points and Less high-risk score < 2 points) received 1 g/kg intravenous immunoglobulin treatment. The response rate and the incidence of coronary artery lesions at 4 weeks after treatment were evaluated in each group. Results: The treatment response rates in the high-risk (n = 110), moderate-risk (n = 80), and low-risk (n = 87) groups were 74.5, 72.5, and 77.0%, respectively. Coronary artery lesions occurred in 7.3, 3.8, and 2.3% of patients in the high-, moderate-, and low-risk groups, respectively. There were no significant differences between the groups regarding treatment response or coronary artery lesion rate. Conclusion: The therapeutic response rate and the therapeutic effect of low-dose intravenous immunoglobulin in the low-risk group identified with our new scoring were satisfactory. Stratified therapies for patients with Kawasaki disease based on the scoring system may be useful.

scholarly journals Timing of Intravenous Immunoglobulin Treatment and Risk of Coronary Artery Abnormalities in Children with Kawasaki Disease

2014 ◽  
Vol 55 (5) ◽  
pp. 387-392 ◽  
Author(s):  
Aswine K. Bal ◽  
Deepa Prasad ◽  
Maria Angela Umali Pamintuan ◽  
Elizabeth Mammen-Prasad ◽  
Anna Petrova
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Coronary Artery Abnormalities ◽  
Immunoglobulin Treatment

A meta-analysis of re-treatment for intravenous immunoglobulin-resistant Kawasaki disease

2015 ◽  
Vol 25 (6) ◽  
pp. 1182-1190 ◽  
Author(s):  
Xi Yang ◽  
Guiying Liu ◽  
Yaqian Huang ◽  
Stella Chen ◽  
Junbao Du ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Coronary Artery ◽  
Body Temperature ◽  
Kawasaki Disease ◽  
Confidence Interval ◽  
Intravenous Immunoglobulin ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Coronary Artery Lesions ◽  
Immunoglobulin Treatment

AbstractObjectiveTo determine the optimal drug therapy for intravenous immunoglobulin-resistant Kawasaki disease.MethodsStudies regarding drug therapy for intravenous immunoglobulin-resistant Kawasaki disease were selected from medical electronic databases including PubMed, Medline, Elsevier, and Springer Link. The effectiveness in terms of temperature recovery and coronary artery damage was compared between a second intravenous immunoglobulin treatment and glucocorticosteroid treatment for children with intravenous immunoglobulin-resistant Kawasaki disease using meta-analysis with Review Manager 5.3 software. Indices to evaluate the effects were body temperature, biomarker levels, and coronary artery lesions detected by echocardiography. Results are reported as relative risks or odds ratio with a 95% confidence interval and p<0.05.ResultsMeta-analysis included 52 patients in the second intravenous immunoglobulin treatment group and 75 patients in the glucocorticosteroid treatment control group from four studies that met our inclusion criteria. Temperatures of patients who received glucocorticosteroid treatment were effectively controlled compared with those who received a second intravenous immunoglobulin treatment (relative risk=0.73, 95% confidence interval: 0.58–0.92, p=0.007). There were no differences, however, in the incidence of coronary artery lesions between the two groups (odds ratio=1.55, 95% confidence interval: 0.57–4.20, p=0.39).ConclusionsGlucocorticosteroids are more effective in controlling body temperature compared with intravenous immunoglobulin re-treatment in intravenous immunoglobulin-resistant Kawasaki disease children; however, glucocorticosteroids and intravenous immunoglobulin re-treatment showed no difference in the prevention of coronary artery lesions.

scholarly journals Predicting IVIG resistance in UK Kawasaki disease

2015 ◽  
Vol 100 (4) ◽  
pp. 366-368 ◽  
Author(s):  
Sarah Davies ◽  
Natalina Sutton ◽  
Sarah Blackstock ◽  
Stuart Gormley ◽  
Clive J Hoggart ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Corticosteroid Treatment ◽  
C Reactive Protein ◽  
Japanese Children ◽  
Coronary Artery Abnormalities ◽  
Reactive Protein ◽  
Ivig Resistance ◽  
Increased Risk

The Kobayashi score (KS) predicts intravenous immunoglobulin (IVIG) resistance in Japanese children with Kawasaki disease (KD) and has been used to select patients for early corticosteroid treatment. We tested the ability of the KS to predict IVIG resistance and coronary artery abnormalities (CAA) in 78 children treated for KD in our UK centre. 19/59 children were IVIG non-responsive. This was not predicted by a high KS (11/19 IVIG non-responders, compared with 26/40 responders, had a score ≥4; p=0.77). CAA were not predicted by KS (12/20 children with CAA vs 25/39 with normal echo had a score ≥4; p=0.78). Low albumin and haemoglobin, and high C-reactive protein were significantly associated with CAA. The KS does not predict IVIG resistance or CAA in our population. This highlights the need for biomarkers to identify children at increased risk of CAA, and to select patients for anti-inflammatory treatment in addition to IVIG.

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