Management of acute and refractory Kawasaki disease.

Abstract

Acute Kawasaki disease (KD) is treated with high-dose intravenous immunoglobulin (IVIG), which is proven to decrease the incidence of coronary artery aneurysms from 25% to less than 5%. Aspirin is also given, although the evidence base is less secure. There is increasing evidence for steroid therapy as adjunctive primary therapy with IVIG, especially in Asian children. Approximately 10-30% of patients fail to respond to the initial IVIG and are at increased risk of coronary artery aneurysms. The optimal treatment for IVIG-nonresponsive KD remains controversial. Management options include further dose(s) of IVIG, corticosteroids, TNF-α blockade, cyclosporin A, anti-IL-1 and anti-CD20 therapy. In this article, the authors review the current evidence for treatment of acute KD and discuss options for IVIG nonresponders.

• Authors: Carline E Tacke, David Burgner, Irene M Kuipers, Taco W Kuijpers
• Journal: Expert review of anti-infective therapy (Expert Rev Anti Infect Ther) Vol. 10 Issue 10 Pg. 1203-15 (Oct 2012) ISSN: 1744-8336 [Electronic] England
• PMID: 23199405 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal, Murine-Derived
• Enzyme Inhibitors
• Immunoglobulins, Intravenous
• Tumor Necrosis Factor-alpha
• Rituximab
• Cyclosporine
• Aspirin
• Methotrexate

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Aspirin (therapeutic use)
• Chemotherapy, Adjuvant
• Coronary Aneurysm (etiology, prevention & control)
• Cyclosporine (therapeutic use)
• Enzyme Inhibitors (therapeutic use)
• Humans
• Immunoglobulins, Intravenous (administration & dosage, therapeutic use)
• Methotrexate (therapeutic use)
• Mucocutaneous Lymph Node Syndrome (complications, drug therapy)
• Rituximab
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)