Low-dose methotrexate therapy for intravenous immunoglobulin-resistant Kawasaki disease.

Abstract:

PURPOSE:The aim of this study was to evaluate the efficacy of low-dose oral methotrexate (MTX) as a treatment for patients with Kawasaki disease (KD) which was resistant to intravenous immunoglobulin (IVIG). PATIENTS AND METHODS:The patients who had persistent or recrudescent fever after treatment with IVIG were subsequently treated with low-dose oral MTX [10mg/body surface area (BSA)] once weekly. RESULTS:Seventeen patients developed persistent or recrudescent fever after treatment of KD with IVIG and were consequently given MTX. The proportion of children with coronary artery lesions (CALs) was 76%. The median value of maximum body temperatures decreased significantly within 24 hours of MTX therapy (38.6 degrees C vs. 37.0 degrees C, p < 0.001). The median CRP (C-reactive protein) level was found to be significantly lower 1 week after administering the first dose of MTX (8.9mg/dL vs. 1.2mg/dL, p < 0.001). The median duration of fever before MTX treatment was shorter in CALs (-) group than in CALs (+) group (7 days vs. 10 days, p = 0.023). No adverse effects of MTX were observed. CONCLUSION:MTX treatment for IVIG-resistant KD resulted in quick resolution of fever and rapid improvement of inflammation markers without causing any adverse effects. MTX therapy should further be assessed in a multicenter, placebo-blinded trial to evaluate whether it also improves coronary artery outcome.

journal_name

Yonsei Med J

journal_title

Yonsei medical journal

authors

Lee TJ,Kim KH,Chun JK,Kim DS

doi

10.3349/ymj.2008.49.5.714

subject

Has Abstract

pub_date

2008-10-31 00:00:00

pages

714-8

issue

5

eissn

0513-5796

issn

1976-2437

pii

200810714

journal_volume

49

pub_type

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