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

Yonsei Med J. 2018 Jan;59(1):113-118. doi: 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.

Keywords: Kawasaki disease; coronary artery lesion; immunoglobulin-resistant Kawasaki disease; methotrexate.

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
  • Methotrexate / therapeutic use*
  • Mucocutaneous Lymph Node Syndrome / blood
  • Mucocutaneous Lymph Node Syndrome / drug therapy*
  • Retrospective Studies
  • Steroids / therapeutic use
  • Treatment Outcome

Substances

  • Immunoglobulins, Intravenous
  • Steroids
  • C-Reactive Protein
  • Methotrexate