Tuesday, 19 Nov 2019

You are here

Cyclosporin and IVIG Effective in Kawasaki's Disease

A Lancet study has shown that adding cyclosporin to intravenous immunoglobulin (IVIG) Kawasaki disease patients, who were predicted to be resistant to IVIG, was both safe and effective in averting severe coronary artery outcomes.

There are genetic studies suggesting upregulated calcium-nuclear factor of activated T cells pathway in the pathogenesis of Kawasaki disease.  Moreover there are patients who are predicted to be resistent to IVIG therapy. Thus, this trial set out to assess if targeting these T cells with cyclosporin (CsA) would avert coronary artery abnormalities in Kawasaki patients.

This open-label, multicenter trial from Japan (2014 to 201) enrolled 175 Kawasaki patients predicted to be at higher risk for IVIG resistance and randomized them to receive either IVIG plus CsA (5 mg/kg/D for 5 days) or IVIG. The primary endpoint was incidence of coronary artery abnormalities at  week 12.

Data pm 173 patients showed that coronary artery abnormalities:

  • CsA + IVIG = 14% (Risk ratio 0·46; 95% CI 0·25–0·86; p=0·010)
  • IVIG alone = 31%

Adverse events were not different between the groups (9% vs 7%).

The addition of CsA to IVIG yielded more favourable coronary artery outcomes in Kawasaki disease patients who were predicted to be unresponsive to IVIG.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Part 1:  The “P” in Prednisone stands for Poison...and Other Pearls

Everyone has life hacks.  Years of experience and doing the same things repetitively allow us to figure out little tricks to make life easier. A rat in a maze, finding itself at a dead end, will back up and search for a clearing. If this rat encounters its neighbor, it will transmit that information so the second rat won’t make the same mistake.

Protective Effects of ASA and Vasodilators in Systemic Sclerosis

A large cohort study suggests that the use of vasodilators and aspirin (ASA) in systemic sclerosis (SSc) may yield favorable  cardiovascular outcomes.

Myositis Patients at High Risk of Opportunistic Infections

Among patients with systemic rheumatic diseases, the highest incidence of opportunistic infections was seen in those with polymyositis/dermatomyositis (PM/DM), Taiwanese researchers found.

Warfarin Superior to Xarelto in Antiphospholipid Syndrome

A 3 year, multicenter, European, study shows that rivaroxaban was inferior to warfarin in preventing thrombosis in patients with antiphospholipid syndrome (APS) according to the Annals of Internal Medicine. Thus despite the inconvenience of warfarin, it remains the best option for patients with APS.

Declining Trends in Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis Mortality in the USA

Annals of Internal Medicine reports that age-adjusted mortality rates for antineutrophil cytoplasmic autoantibody–associated vasculitides (AAV) have improved over time - with a decline of nearly 2 percent per year in the United States from 1999 to 2017. Nevertheless, long-term outcomes continue to lag behind mortality rates of the general population.