Immunomodulatory drugs for intravenous immunoglobulin-resistant Kawasaki disease

McCrindle, 2017Wardle, 2017

For patients who are resistant to intravenous immunoglobulin (IVIg), high-dose pulse intravenous corticosteroids (with or without a subsequent taper of oral corticosteroids) may be considered:

  • as an alternative to a second infusion of IVIg
  • for patients with persistent or recurrent fever after a second infusion of IVIg infusion.

If indicated, the usual dosage for pulse intravenous corticosteroids in IVIg-resistant Kawasaki disease is:

methylprednisolone sodium succinate 30 mg/kg, up to 1000 mg, intravenously over 1 hour, daily for up to 3 days methylprednisolone sodium succinate methylprednisolone methylprednisolone

FOLLOWED BY (if required)

prednisolone (or prednisone) 2 mg/kg/day (up to 60 mg) orally, daily in the morning, tapering the dose down over 2 to 3 weeks to stop. prednis ol one prednis(ol)one prednis(ol)one

For additional considerations specific to systemic corticosteroid use, see Specific considerations for use of systemic corticosteroids.

Highly inflamed patients who fail to respond to a second dose of IVIg and systemic corticosteroids require additional treatment to control inflammation, in consultation with a specialistThe Royal Children's Hospital (RCH) Melbourne. Treatments including infliximab and ciclosporin are supported by small scale trials.