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Resistant Kawasaki: combo may be best rescue tx.


LOS ANGELES -- 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 WIG plus aspirin.

In a nonrandomized study of 375 consecutive patients resistant to initial standard therapy with IVIG plus aspirin, 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, said Dr. Tohru 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. 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.

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.

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Title Annotation:CLINICAL ROUNDS
Author:Jancin, Bruce
Publication:Pediatric News
Date:Apr 1, 2013
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