What is it about?
Background: The prevalence of coronary artery lesions (CAL) is higher in older children compared with younger children. Anti-inflammatory drugs including aspirin appeared to have a negative impact on the suppressive effects of initial intravenous immunoglobulin (IVIG) therapy for CAL development during the acute phase of Kawasaki disease and an initial single IVIG therapy with the delayed use of anti-inflammatory drugs (DUA) might be effective for CAL suppression. The outcomes regarding CAL and non-cardiac complications after single IVIG therapy with DUA remain unclear. Aims: To ascertain the outcomes of the older children with Kawasaki disease who received single IVIG therapy with DUA. Methods: The retrospective data of 25 children who were ≧ 60 months old and received this therapy between 2004 and 2017 in our department were collected and outcomes were investigated. Anti-inflammatory drugs were initiated within 24 hours after the end of initial IVIG infusion. Results: No patients were associated with CAL. However, three patients were associated with non-cardiac complications including transient blindness, intractable arthritis, and prolonged restriction of cervical movement caused by atlantoaxial rotatory fixation. All three children were IVIG therapy-resistant and had statistically higher C-reactive protein values (median: 9.64 interquartile range: 7.82-18.29 vs. 1.905: 0.76-4.77 mg/dL, P = 0.007), neutrophil counts (9545: 9312-9660 vs. 2766.5: 1936-3812 /mm3, P = 0.006), and neutrophil to lymphocyte ratios (10.38: 4.85-11.29 vs. 1.44: 0.92-2.69, P = 0.006) after IVIG therapy compared to those without complications. Conclusion: Initial IVIG therapy-resistant three patients with high values of inflammatory biomarkers after initial therapy with DUA were associated with non-cardiac complications.
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Why is it important?
An onset at an older age is an independent risk factor for the development of cardiovascular sequelae in Kawasaki disease. The prevalence of CAL is higher in older children than in younger children. This study suggested that an initial full dose IVIG therapy of 2 g/kg body weight/dose with DUA may be useful for suppression of CAL caused by Kawasaki disease in older children.
Perspectives
Patients who received initial IVIG with DUA may not receive a negative impact of the suppressive effects of anti-inflammatory drugs to IVIG therapy until the start time of anti-inflammatory drugs administration. However, patients who received initial IVIG therapy with concomitant use of anti-inflammatory drugs may receive a negative impact of anti-inflammatory drugs during IVIG therapy. This difference may be relevant to the superior efficacy of IVIG with DUA to that of IVIG with concomitant use of anti-inflammatory drugs.
Toshimasa Nakada
Aomori Prefectural Central Hospital
Read the Original
This page is a summary of: Outcomes of Older Children with Kawasaki Disease Who Received Intravenous Immunoglobulin Therapy with Delayed Use of Anti-inflammatory Drugs, Journal of Advances in Medicine and Medical Research, January 2017, Sciencedomain International,
DOI: 10.9734/jammr/2017/34047.
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