What is it about?
Abstract : The objective of this study is the description of clinical outcomes regarding the absence of rescue therapy of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. I investigated the clinical outcomes of 33 IVIG-resistant patients who received the initial single IVIG therapy with the delayed use of anti-inflammatory drugs (DUA). These patients were divided into two groups: 11 patients who received rescue therapies (rescue group) and 22 patients who did not receive rescue therapy (non-rescue group). One patient of rescue group developed coronary artery lesions (CAL). None of the patients of non-rescue group developed CAL. The prevalence of persistent fever between rescue and non-rescue groups at 3 days and 4 days after initial IVIG therapy was 100% vs. 77% ( P = 0.144 ) and 100% vs. 18% ( P < 0.001 ), respectively. The C-reactive protein value, neutrophil counts, serum albumin levels, and sodium levels were significantly different between two groups at median 3 days after initial IVIG therapy. Two-thirds of the IVIG-resistant patients diagnosed at 24 h after completion of the initial IVIG therapy with DUA did not develop CAL after 30 days of illness without rescue therapies. The rescue therapy at this time may lead to overtreatment.
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Why is it important?
The establishment of the appropriate rescue therapies is important for suppression of CAL and for safety of the treatment in the acute phase of Kawasaki disease. This study showed that the clinical outcomes of the two subgroups in the IVIG-resistant patients were significantly different and that these two groups could be separated at 3 to 4 days after initial IVIG therapy.
Perspectives
Two-thirds of the IVIG-resistant patients diagnosed at 24 h after completion of the initial IVIG therapy with DUA did not develop CAL after 30 days of illness without rescue therapies. The rescue therapy at this time may lead to overtreatment. The data regarding Egami score, defervescence, and laboratory tests suggested that the patients of the rescue group were more severely ill than those of the non-rescue group. However, the prevalence of CAL were similar between the two groups. These findings suggested that the rescue therapies at 3 to 4 days after initial IVIG therapy were effective for the suppression of CAL in the rescue group patients. On the other hand, none of the patients in the non-rescue group received rescue therapies for resistance and all of these patients recovered by themselves without further treatment for resistance. This finding suggested that the decision for rescue therapies at 3 to 4 days after initial IVIG therapy was appropriate for the patients in the non-rescue group. Three to 4 days after initial IVIG therapy with DUA may be appropriate for the decision for rescue therapies for IVIG-resistant patients with Kawasaki disease.
Toshimasa Nakada
Aomori Prefectural Central Hospital
Read the Original
This page is a summary of: Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease, IOSR Journal of Pharmacy (IOSRPHR), August 2016, IOSR Journals,
DOI: 10.9790/3013-068014047.
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