Low-dose Methotrexate Therapy for Intravenous Immunoglobulin-resistant Kawasaki Disease.
10.3349/ymj.2008.49.5.714
- Author:
Taek Jin LEE
1
;
Ki Hwan KIM
;
Jin Kyong CHUN
;
Dong Soo KIM
Author Information
1. Department of Pediatrics, College of Medicine, Pochon CHA University, Seongnam, Korea. dskim6634@yuhs.ac
- Publication Type:Original Article
- Keywords:
Kawasaki disease;
methotrexate;
resistance to immunoglobulin
- MeSH:
Child;
Child, Preschool;
Drug Resistance;
Female;
Humans;
Immunoglobulins, Intravenous/*therapeutic use;
Infant;
Male;
Methotrexate/administration & dosage/*therapeutic use;
Mucocutaneous Lymph Node Syndrome/*drug therapy;
Treatment Outcome
- From:Yonsei Medical Journal
2008;49(5):714-718
- CountryRepublic of Korea
- Language:English
-
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 (38.6degrees C vs. 37.0degrees 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.
