The combination of intravenous immunoglobulin, aspirin, and prednisolone appears to be the most effective form of rescue therapy for patients with acute Kawasaki disease who don’t respond to initial IVIG plus aspirin, according to a large Japanese observational study.
Dr. Tohru Kobayashi reported on 375 consecutive patients resistant to initial standard therapy with IVIG plus aspirin. In nonrandomized fashion, 141 received another course of IVIG as first-line rescue therapy, 80 got prednisolone, and 154 were put on IVIG plus prednisolone. All patients also received aspirin.
The rescue therapy failure rate was significantly lower in patients who got IVIG combined with prednisolone, 12.3%, compared with 38.3% with IVIG alone and 30% with prednisolone, according to Dr. Kobayashi of Gunma University in Maebashi, Japan.
Moreover, the prevalence of coronary artery aneurysms at 1 month was 6.5% with combination rescue therapy, significantly lower than the 14.9% figure with rescue IVIG or the 16.3% prevalence with prednisolone, Dr. Kobayashi said at the annual scientific sessions of the American Heart Association.
Compared with the rescue IVIG group, patients who received rescue IVIG plus prednisolone had an adjusted 84% lower risk of failing to respond to initial rescue therapy. They were also 61% less likely to have a coronary artery aneurysm at 1 month.
This study was funded by the Japanese Ministry of Health, Labor, and Comprehensive Research on Practical Application of Medical Technology. Dr. Kobayashi reported having no financial conflicts.