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Stratified therapy for Kawasaki disease using a new scoring system to predict the response to a lower dose of intravenous immunoglobulin therapy

Published online by Cambridge University Press:  10 June 2021

Misa Matsuura Open the ORCID record for Misa Matsuura [Opens in a new window] ,
Daisuke Sugawara ,
Eishi Makita Open the ORCID record for Eishi Makita [Opens in a new window] ,
Yuka Hirakubo ,
Kazuhito Nonaka Open the ORCID record for Kazuhito Nonaka [Opens in a new window] ,
Shinichiro Yamashita  and
Ko Ichihashi
Misa Matsuura
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Daisuke Sugawara
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Eishi Makita*
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Yuka Hirakubo
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Kazuhito Nonaka
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Shinichiro Yamashita
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Ko Ichihashi
Affiliation:
Department of Pediatrics, Saitama Medical Center, Jichi Medical University, Saitama, Japan
*
Author for correspondence: Dr E. Makita, MD, Department of Pediatrics, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan. Tel: +81 48 647 2111; Fax: +81 648 0960. E-mail: r0947em@jichi.acjp
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Abstract

Background:

Several studies have reported treatment options for patients with Kawasaki disease refractory to standard immunoglobulin therapy; however, no studies have reported low-dose immunoglobulin therapy for patients with a low risk of Kawasaki disease.

Methods:

A total of 277 patients with Kawasaki disease were included in this study. We used Kobayashi score and our Less high-risk score to divide the patients into three groups. Patients in the high-risk group (Kobayashi score ≥ 5 points) received 2 g/kg intravenous immunoglobulin and prednisolone. Patients in the moderate-risk group (Kobayashi score < 5 points and Less high-risk score ≥ 2 points) received 2 g/kg intravenous immunoglobulin treatment. Patients in the low-risk group (Kobayashi score < 5 points and Less high-risk score < 2 points) received 1 g/kg intravenous immunoglobulin treatment. The response rate and the incidence of coronary artery lesions at 4 weeks after treatment were evaluated in each group.

Results:

The treatment response rates in the high-risk (n = 110), moderate-risk (n = 80), and low-risk (n = 87) groups were 74.5, 72.5, and 77.0%, respectively. Coronary artery lesions occurred in 7.3, 3.8, and 2.3% of patients in the high-, moderate-, and low-risk groups, respectively. There were no significant differences between the groups regarding treatment response or coronary artery lesion rate.

Conclusion:

The therapeutic response rate and the therapeutic effect of low-dose intravenous immunoglobulin in the low-risk group identified with our new scoring were satisfactory. Stratified therapies for patients with Kawasaki disease based on the scoring system may be useful.

Keywords

Kawasaki diseaseintravenous immunoglobulinstratified therapy
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022 , pp. 405 - 409
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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