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The Clinical Utility and Safety of a New Strategy for the Treatment of Refractory Kawasaki Disease.
Ebato, Takasuke; Ogata, Shohei; Ogihara, Yoshihito; Fujimoto, Mayu; Kitagawa, Atsushi; Takanashi, Manabu; Ishii, Masahiro.
Afiliação
  • Ebato T; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Ogata S; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Ogihara Y; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Fujimoto M; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Kitagawa A; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Takanashi M; Department of Pediatrics, Kitasato University, Kanagawa, Japan.
  • Ishii M; Department of Pediatrics, Kitasato University, Kanagawa, Japan. Electronic address: Ishiim@med.kitasato-u.ac.jp.
J Pediatr ; 191: 140-144, 2017 12.
Article em En | MEDLINE | ID: mdl-29173297
OBJECTIVE: To assess the clinical utility and safety of a strategy for refractory Kawasaki disease, defined by Egami score ≥3. STUDY DESIGN: First-line treatment was with intravenous methylprednisolone (30 mg/kg, 2 hours, 1 dose) plus intravenous immunoglobulin (2 g/kg, 24 hours) treatment. Patients resistant to first-line treatment received additional intravenous immunoglobulin as a second-line treatment. Patients resistant to second-line treatment who had received Bacillus Calmette-Guérin vaccination 6 months earlier were treated with infliximab; otherwise, plasma exchange was performed. A total of 71 refractory patients with Kawasaki disease (median age: 2.4 years) of 365 patients with Kawasaki disease were treated according to our strategy from April 2007 to April 2016. Treatment resistance was defined as a persistent fever at 36 hours after treatment. We evaluated coronary artery lesions at the time of the diagnosis, at 1 month, and at 1 year after the diagnosis in accordance with the American Heart Association guidelines and the criteria of the Japanese Ministry of Health, Labour, and Welfare. RESULTS: First-line therapy was effective for 58 of 71 patients (81.6%), and second-line therapy was effective for 9 of 13 patients (69.2%). At third line, 3 patients were treated by infliximab, and 1 was treated with plasma exchange. Of the 18 patients with coronary artery abnormalities at diagnosis, 13 patients at 1 month and 6 patients at 1 year had coronary artery dilatation (median z score 3.0, 2.6, and 1.4, respectively). There were no patients with coronary artery aneurysm (CAA). CONCLUSIONS: Our strategy for refractory Kawasaki disease was safe and effective in preventing CAA.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Troca Plasmática / Metilprednisolona / Imunoglobulinas Intravenosas / Infliximab / Fatores Imunológicos / Anti-Inflamatórios / Síndrome de Linfonodos Mucocutâneos Tipo de estudo: Etiology_studies / Guideline Aspecto: Patient_preference Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Japão País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Troca Plasmática / Metilprednisolona / Imunoglobulinas Intravenosas / Infliximab / Fatores Imunológicos / Anti-Inflamatórios / Síndrome de Linfonodos Mucocutâneos Tipo de estudo: Etiology_studies / Guideline Aspecto: Patient_preference Limite: Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Pediatr Ano de publicação: 2017 Tipo de documento: Article País de afiliação: Japão País de publicação: Estados Unidos