Yonsei Med J.  2014 Sep;55(5):1260-1266. 10.3349/ymj.2014.55.5.1260.

Clinical Outcomes of Initial Dexamethasone Treatment Combined with a Single High Dose of Intravenous Immunoglobulin for Primary Treatment of Kawasaki Disease

• Lim YJ
• Jung JW

• KMID: 1799489
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1260

Abstract

PURPOSE
To investigate the clinical effects of a single high dose intravenous immunoglobulin (IVIG) combined with initial dexamethasone as a primary treatment on Kawasaki disease (KD).
MATERIALS AND METHODS
Between January 2008 and December 2010, we reviewed the medical records of 216 patients with complete KD patients that were admitted to a single medical center. 106 patients were treated with a single high dose of IVIG (2 g/kg) alone and 110 patients received IVIG and dexamethasone (0.3 mg/kg per day for three days).
RESULTS
The combined IVIG plus dexamethasone patient group had a significantly shorter febrile period and duration of hospital stay (1.4+/-0.7 days vs. 2.0+/-1.2 days, p<0.001; 5.8+/-1.7 days vs. 6.9+/-2.5 days, p<0.001, respectively) than the IVIG alone group. The combined IVIG plus dexamethasone group required IVIG retreatment significantly less than the IVIG only group (12.7% vs. 32%, p=0.003). After completion of the initial IVIG, C-reactive protein levels in the combined IVIG plus dexamethasone group were significantly lower than those in the IVIG only group (2.7+/-4.0 mg/dL vs. 4.6+/-8.7 mg/dL, p=0.03). In the combined IVIG plus dexamethasone group, the incidence of coronary artery lesions tended to be lower without worse outcomes at admission after initial infusion of IVIG and in follow-up at two months; however, the differences were not significant (8.2% vs. 11.3%, p=0.22; 0.9% vs. 2.8%, p=0.29).
CONCLUSION
Initial combined therapy with dexamethasone and a single high-dose of IVIG resulted in an improved clinical course, in particular a shorter febrile period, less IVIG retreatment, and shorter hospital stay without worse coronary outcomes.

Keyword

Dexamethasone; high-dose intravenous immunoglobulin; combined therapy; Kawasaki disease

MeSH Terms

Child, Preschool
Dexamethasone/administration & dosage/adverse effects/*therapeutic use
Female
Fever/drug therapy
Glucocorticoids/administration & dosage/adverse effects/*therapeutic use
Humans
Immunoglobulins, Intravenous/administration & dosage/adverse effects/therapeutic use
Immunologic Factors/administration & dosage/adverse effects/*therapeutic use
Infant
Length of Stay
Male
Mucocutaneous Lymph Node Syndrome/*drug therapy
Treatment Outcome
Dexamethasone
Glucocorticoids
Immunoglobulins, Intravenous
Immunologic Factors

Figure

• 

  Fig. 1 Changes in laboratory findings between the IVIG only group and IVIG plus dexamethasone group (DEX+IVIG): (A) for mean C-reactive protein (CRP), (B) for mean platelet count, and (C) for mean erythrocyte sedimentation rate (ESR). *p<0.05, IVIG only group vs. DEX+IVIG group. DEX, dexamethasone; IVIG, intravenous immunoglobulin.

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