Corticosteroids & standard IV Immunoglobulin combo therapy m
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In a largest study to date assessing the effectiveness of primary corticosteroid treatment administered in combination with standard intravenous immunoglobulin treatment for patients with Kawasaki disease judged to be at higher risk of developing blood vessel complications made initial treatment more successful and prevented these complications, according to new research published today in the Journal of the American Heart Association.

Kawasaki disease, which occurs most often in children younger than 5 years old, causes inflammation of the blood vessels, particularly the coronary arteries that supply fresh blood to the heart muscle.

The criteria for diagnosis is when a child has a fever for five days or longer (unless interrupted by treatment) along with multiple other defining symptoms that can include a rash over the abdomen, swollen and red hands and feet, bloodshot eyes, swollen lymph glands, and redness and swelling of the mouth, lips, throat and tongue.

Researchers identified 1,593 Kawasaki disease patients under the age of 18 who were first treated with standard IV immunoglobulin with aspirin. Outcomes were compared with another set of 1,593 Kawasaki disease patients who were likely to have been initially treated with corticosteroids in combination with the standard therapy.

Compared with standard IV immunoglobulin treatment, the researchers found:

-- Initial combination treatment (immunoglobulin plus aspirin and corticosteroids) reduced the need for a second course of therapy by 35%.

-- Initial combination treatment reduced the risk of coronary artery abnormalities by 47%.

-- Delivering a low-dosage of corticosteroids over many days was more beneficial than a high-dose pulse over fewer days or typically just one day.

“It was surprising to see the dramatic results of our analysis. Clinicians should consider initial combination treatment with multiple-dose corticosteroids for high-risk Kawasaki disease patients,” researchers said.

Source: https://www.ahajournals.org/doi/10.1161/JAHA.119.015308
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