PMID- 33341911
OWN - NLM
STAT- MEDLINE
DCOM- 20210202
LR  - 20210202
IS  - 1179-1918 (Electronic)
IS  - 1173-2563 (Linking)
VI  - 41
IP  - 1
DP  - 2021 Jan
TI  - Targeted Use of Prednisolone with Intravenous Immunoglobulin for Kawasaki 
      Disease.
PG  - 77-88
LID - 10.1007/s40261-020-00984-6 [doi]
AB  - BACKGROUND AND OBJECTIVES: Intravenous immunoglobulin (IVIG) therapy for 
      acute-stage Kawasaki disease (KD) is the first-line treatment for preventing the 
      development of coronary artery aneurysms (CAA). Corticosteroids (prednisolone) 
      and infliximab are often used in patients at a high risk of CAA or those with CAA 
      at diagnosis; however, there are only a few reports of non-responders to 
      corticosteroids as an adjuvant therapy or rescue alternative to IVIG. In this 
      study, we compared the therapeutic effects of primary and secondary prednisolone 
      with IVIG for KD. METHODS: We established the following three protocols: A was a 
      secondary rescue prednisolone protocol; B was no prednisolone and second-line 
      infliximab protocol, and C was the primary prednisolone protocol. The indication 
      for prednisolone administration was based on the following: primary prednisolone 
      administration, Kobayashi score; and secondary administration, Shizuoka score. 
      RESULTS: Four hundred and sixty-nine patients were enrolled in the three 
      protocols. A comparison between primary and secondary prednisolone and IVIG, as 
      the first-line therapy revealed that the number of first non-responders in C 
      group was 7 (8.3%), which was significantly lower than the 50 (20.9%) in A group. 
      There was a significant difference in the first and second non-responders among 
      the three groups, and the number of non-responders in A group was 6 (2.5%), which 
      was significantly lower than the 13 (9.9%) in B group (p < 0.001, by Bonferroni 
      test). The multivariate logistic regression analysis showed that IVIG 
      non-responders among the protocol groups had an adjusted odds ratio of 6.47. 
      Fifteen IVIG non-responders were administered infliximab as a second-line 
      therapy, and of them, 9 (60%) showed therapy resistance. CAA occurred in 21 
      patients (4.6%). There was no significant difference among each protocol group. 
      CONCLUSIONS: The number of IVIG non-responders in the group with prednisolone 
      administration was lower than that in the group without prednisolone 
      administration. Secondary rescue infliximab therapy for IVIG non-responders 
      resulted in a lower defervescence effect than the secondary rescue IVIG with 
      prednisolone administration. Further prospective randomized studies are needed to 
      identify factors useful for preventing IVIG non-responders and determine the 
      optimal rescue therapy for preventing CAA.
FAU - Sakai, Hidemasa
AU  - Sakai H
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Department of Pediatrics, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
FAU - Iwashima, Satoru
AU  - Iwashima S
AUID- ORCID: 0000-0003-2713-321X
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan. 
      iwashima3617@gmail.com.
AD  - Department of Pediatrics, Chutoen General Medical Center, Kakegawa, Japan. 
      iwashima3617@gmail.com.
FAU - Sano, Shinichiro
AU  - Sano S
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Department of Pediatrics, Hamamatsu Medical Center, Shizuoka, Japan.
FAU - Akiyama, Naoe
AU  - Akiyama N
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Department of Pediatrics, Fuji City General Hospital, Shizuoka, Japan.
FAU - Nagata, Eiko
AU  - Nagata E
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Center for Clinical Research, Hamamatsu University Hospital, Shizuoka, Japan.
FAU - Harazaki, Masashi
AU  - Harazaki M
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Department of Pediatrics, Medical Genetics, Shizuoka General Hospital, Shizuoka, 
      Japan.
FAU - Fukuoka, Tetuya
AU  - Fukuoka T
AD  - The Shizuoka Kawasaki Disease Study Group, Shizuoka, Japan.
AD  - Department of Pediatrics, Medical Genetics, Shizuoka Saiseikai General Hospital, 
      Shizuoka, Japan.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20201220
PL  - New Zealand
TA  - Clin Drug Investig
JT  - Clinical drug investigation
JID - 9504817
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 9PHQ9Y1OLM (Prednisolone)
RN  - B72HH48FLU (Infliximab)
SB  - IM
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Immunoglobulins, Intravenous/*administration & dosage/therapeutic use
MH  - Infant
MH  - Infliximab/*administration & dosage
MH  - Male
MH  - Mucocutaneous Lymph Node Syndrome/*drug therapy
MH  - Prednisolone/*administration & dosage
MH  - Prospective Studies
EDAT- 2020/12/21 06:00
MHDA- 2021/02/03 06:00
CRDT- 2020/12/20 20:31
PHST- 2020/10/29 00:00 [accepted]
PHST- 2020/12/21 06:00 [pubmed]
PHST- 2021/02/03 06:00 [medline]
PHST- 2020/12/20 20:31 [entrez]
AID - 10.1007/s40261-020-00984-6 [pii]
AID - 10.1007/s40261-020-00984-6 [doi]
PST - ppublish
SO  - Clin Drug Investig. 2021 Jan;41(1):77-88. doi: 10.1007/s40261-020-00984-6. Epub 
      2020 Dec 20.