We retrospectively reviewed the clinical records of 359 consecutive patients with Kawasaki disease who failed to respond to initial IVIG.
CAAs up to 1 month after treatment were less common in the IVIG+prednisolone group (15.9 % ) than in the IVIG group (28.7 % , P?=?.005) and the prednisolone group (30.6 % , P?=?.01). The IVIG+prednisolone group had significantly lower risks of failing to respond to first-line rescue therapy (aOR 0.16, 95 % CI 0.09-0.31), CAAs up to 1 month (aOR 0.46, 95 % CI 0.27-0.90), and CAAs at 1 month (aOR 0.40, 95 % CI 0.18-0.91) than the IVIG group. In the prednisolone and IVIG+prednisolone groups, risk score, day of illness at first-line rescue therapy, prednisolone monotherapy, and resistance to first-line rescue therapy were independent risk factors for CAA. Sex and resistance to first-line rescue therapy were independent risk factors in the IVIG group.
IVIG+prednisolone may be superior to IVIG or prednisolone as first-line rescue therapy in the treatment of IVIG nonresponders. To establish the efficacy of rescue therapy with IVIG+prednisolone following nonresponse to initial IVIG, a prospective randomized trial is warranted.