Yonsei Med J.  2018 Jan;59(1):113-118. 10.3349/ymj.2018.59.1.113.

Clinical Outcomes of Low-Dose Methotrexate Therapy as a Second-Line Drug for Intravenous Immunoglobulin-Resistant Kawasaki Disease

• Jang H
• Kim KY
• Kim DS

• KMID: 2418857
• DOI: http://doi.org/10.3349/ymj.2018.59.1.113

Abstract

PURPOSE
Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease (KD). However, there is still no standard treatment for IVIG-resistant KD. This study aimed to evaluate the efficacy of low-dose methotrexate (MTX) as a treatment for IVIG-resistant KD.
MATERIALS AND METHODS
We retrospectively analyzed 10-year data for patients with IVIG-resistant KD who were administered MTX at Severance Children's Hospital.
RESULTS
The subjects included 75 patients with KD aged 5 months to 9.2 years who had been administered MTX. Their maximum body temperatures decreased significantly within 24 h of therapy. The patients' C-reactive protein levels were significantly lower 1 week after administering the first dose of MTX than those before treatment. No adverse effect for MTX was observed.
CONCLUSION
MTX treatment of IVIG-resistant KD resulted in rapid defervescence, improvement of clinical symptoms, and normalization of acute-phase reactants in all patients. Thus, MTX could be a candidate treatment for IVIG-resistant KD.

Keyword

Kawasaki disease; immunoglobulin-resistant Kawasaki disease; methotrexate; coronary artery lesion

MeSH Terms

C-Reactive Protein/analysis
Child
Child, Preschool
Coronary Vessels/pathology
Demography
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Humans
Immunoglobulins, Intravenous/*therapeutic use
Infant
Male
Methotrexate/administration & dosage/*therapeutic use
Mucocutaneous Lymph Node Syndrome/blood/*drug therapy
Retrospective Studies
Steroids/therapeutic use
Treatment Outcome
Immunoglobulins, Intravenous
Steroids
C-Reactive Protein
Methotrexate

Figure

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  Fig. 1 Annual distribution of methotrexate (MTX) treatment for intravenous immunoglobulin resistant Kawasaki disease.

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  Fig. 2 Fever patterns of the patients with intravenous immunoglobulin resistant Kawasaki disease before and after MTX treatment. MTX, methotrexate.

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  Fig. 3 Serum CRP level of the patients with intravenous immunoglobulin resistant Kawasaki disease before and 7 days after MTX treatment. CRP, C-reactive protein; MTX, methotrexate.

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