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New Perspectives in the Drug Treatment of Kawasaki Disease

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Abstract

Kawasaki disease (KD) has become the leading cause of acquired heart disease in developed countries. Conventional therapy for KD includes intravenous gammaglobulin (2 g/kg as a single dose over 12 hours) and aspirin (acetylsalicylic acid; high dose until the fourteenth day of illness then low dose). Therapy administered within the first 10 days of the onset of the illness has been shown to reduce arterial wall inflammation and thereby prevent the development of coronary artery aneurysm formation.

The majority of patients with KD will respond to conventional therapy. However, the management of nonresponders and patients with complications (such as acute thrombosis and chronic coronary artery changes) remains controversial. In this review article, we address some of these controversies and also describe newer treatment modalities that have been used in the management of patients with KD, both in the acute and convalescent stages of the disease.

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References

  1. Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children [in Japanese]. Jpn J Allergy 1967; 16: 178–222

    CAS  Google Scholar 

  2. Rose V. Kawasaki syndrome: cardiovascular manifestations. J Rheumatol 1990; 17Suppl. 24: 11–4

    Google Scholar 

  3. Furusho K, Kamiya T, Nakano H, et al. High-dose intravenous gamma globulin for Kawasaki disease. Lancet 1984; II: 1055–8

    Article  Google Scholar 

  4. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986; 315: 341–7

    Article  PubMed  CAS  Google Scholar 

  5. Newburger JW, Takahashi M, Beiser AS, et al. A single infusion of intravenous gamma globulin compared to four daily doses in the treatment of acute Kawasaki syndrome. N Engl J Med 1991; 324: 1633–9

    Article  PubMed  CAS  Google Scholar 

  6. Yanagawa H, Yashiro M, Nakamura Y, et al. IV gamma globulin treatment of Kawasaki disease in Japan: results of a nationwide survey. Acta Paediatr 1995; 84: 765–8

    Article  PubMed  CAS  Google Scholar 

  7. Rowley AH, Duffy CE, Shulman ST. Prevention of giant coronary artery aneurysms in Kawasaki disease by intravenous gamma globulin therapy. J Pediatr 1988; 113: 290–4

    Article  PubMed  CAS  Google Scholar 

  8. Newburger JW, Sanders SP, Burns JC, et al. Left ventricular contractility and function in Kawasaki syndrome: effect of intravenous gamma-globulin. Circulation 1989; 79: 1237–46

    Article  PubMed  CAS  Google Scholar 

  9. Rosenfeld EA, Shulman ST, Corydon KE, et al. Comparative safety and efficacy of two immune globulin products in Kawasaki disease. J Pediatr 1995; 126: 1000–3

    Article  PubMed  CAS  Google Scholar 

  10. Fasano MB. Risks and benefits of intravenous immunoglobulin treatment in children. Curr Opin Pediatr 1995; 7: 688–94

    PubMed  CAS  Google Scholar 

  11. Harada K. Intravenous gamma-globulin treatment in Kawasaki disease. Acta Paediatr Jpn 1991; 33(6): 805–10

    Article  PubMed  CAS  Google Scholar 

  12. Nakano H, Ueda K, Saito A, et al. Scoring method for identifying patients with Kawasaki disease at high risk of coronary artery aneurysms. Am J Cardiol 1986; 58: 739–42

    Article  PubMed  CAS  Google Scholar 

  13. Kusakawa S. Long-term administrative care of Kawasaki disease. Acta Paediatr Jpn Overseas Ed 1983; 25: 205–9

    Article  Google Scholar 

  14. Koren G, Silverman E, Sundel R. Decreased protein binding of salicylates in Kawasaki disease. J Pediatr 1991; 118: 456–9

    Article  PubMed  CAS  Google Scholar 

  15. Takahashi M, Mason W, Kawasaki syndrome, Reye syndrome, and aspirin [letter]. Pediatrics 1986; 77(4): 616–7

    PubMed  CAS  Google Scholar 

  16. Lee JH, Hung HY, Huang FY Kawasaki disease with Reye syndrome: report of one case. Chung-Hua Min Kuo Hsiao Erh Ko I Hseuh Hui Tsa Chih 1992; 33(1): 67–71

    CAS  Google Scholar 

  17. Koren G, Schaffer F, Silverman E, et al. Determinants of low serum concentrations of salicylates in patients with Kawasaki disease. J Pediatr 1988; 112: 663–7

    Article  PubMed  CAS  Google Scholar 

  18. Kusakawa S, Tatara K. Efficacies and risks of aspirin in the treatment of Kawasaki disease. Prog Clin Biol Res 1987; 250: 401–13

    PubMed  CAS  Google Scholar 

  19. Terai M, Shulman ST. The prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gamma globulin dose but independent of salicylate dose. J Pediatr 1997; 131: 888–93

    Article  PubMed  CAS  Google Scholar 

  20. Burns JC, Capparelli E, Brown JA, et al. Intravenous gamma globulin treatment and retreatment in Kawasaki Disease. US/Canadian Kawasaki Syndrome Study Group. Pediatr Infect Dis J 1998; 17: 1144–8

    Article  PubMed  CAS  Google Scholar 

  21. Sundel RP, Burns JC, Baker A, et al. Gamma globulin re-treatment in Kawasaki disease. J Pediatr 1993; 123: 657–9

    Article  PubMed  CAS  Google Scholar 

  22. Shulman ST, Rowley AH. Treatment of Kawasaki disease with corticosteroids [letter]. J Pediatr 1996; 129: 484–5

    Article  Google Scholar 

  23. Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics 1979; 63: 175–9

    PubMed  CAS  Google Scholar 

  24. Kan Z, Hoshino K, Ogawa K, et al. Steroid-aspirin combination therapy for treatment of Kawasaki disease [in Japanese]. J Pediatr Pract 1990; 53: 328–31

    Google Scholar 

  25. Wright DA, Newburger JW, Baker A et al. Treatment of immune globulin resistant Kawasaki disease with pulsed doses of corticosteroids. J Pediatr 1996; 128: 146–9

    Article  PubMed  CAS  Google Scholar 

  26. Takahashi K, Naoe S, Oharaseki T, et al. Autopsy cases of Kawasaki disease with ruptured coronary aneurysms. 6th International Kawasaki Disease Symposium; 1999 Feb 11–14; Waikoloa, Hawaii

  27. Sugimura T, Kato H, Inoue O, et al. Intravascular ultrasound of coronary arteries in children: assessment of the wall morphology and the lumen after Kawasaki disease. Circulation 1994; 89: 258–65

    Article  PubMed  CAS  Google Scholar 

  28. Suzuki A, Yamagishi M, Kimura K, et al. Functional behavior and morphology of the coronary artery wall in patients with Kawasaki disease assessed by intravascular ultrasound. J Am Coll Cardiol 1996; 27: 291–6

    Article  PubMed  CAS  Google Scholar 

  29. Fam WM, McGregor M. Effect of nitroglycerin and dipyridamole on regional coronary resistance. Circ Res 1968; 22: 649–59

    Article  PubMed  CAS  Google Scholar 

  30. Feldman RL, Nichols WW, Pepine CJ, et al. Acute effect of intravenous dipyridamole on regional coronary hemodynamics and metabolism. Circulation 1981; 64: 333–4

    Article  PubMed  CAS  Google Scholar 

  31. Kobayashi T, Sone K. Effect of dipyridamole on the blood flow in coronary aneurysms resulting from Kawasaki disease. Pediatr Cardiol 1994; 15: 263–7

    Article  PubMed  CAS  Google Scholar 

  32. Terai M, Ogata M, Sugimoto K, et al. Coronary arterial thrombi in Kawasaki disease. J Pediatr 1985; 106: 76–8

    Article  PubMed  CAS  Google Scholar 

  33. Katayama F, Hiraishi S, Takeda N, et al. Intracoronary urokinase and post-thrombolytic regimen in an infant with Kawasaki disease and acute myocardial infarction. Heart 1997; 78(6): 621–2

    PubMed  CAS  Google Scholar 

  34. Kato H, Inoue O, Ichinose E, et al. Intracoronary urokinase in Kawasaki disease: treatment and prevention of myocardial infarction. Acta Paediatr Jpn 1991; 33: 27–35

    Article  PubMed  CAS  Google Scholar 

  35. Liang CD, Huang SC, Su WJ, et al. Successful intravenous streptokinase treatment of a child with Kawasaki disease complicated by acute myocardial infarction. Catheterization Cardiovasc Diagn 1995; 35(2): 139–45

    Article  CAS  Google Scholar 

  36. Tsubata S, Ichida F, Hamamichi A, et al. Successful thrombolytic therapy using tissue-type plasminogen activator in Kawasaki disease. Pediatr Cardiol 1995; 16: 186–9

    PubMed  CAS  Google Scholar 

  37. Horigome H, Sekijima T, Miyamoto T. Successful thrombolysis with intracoronary administration of tissue plasminogen activator in an infant with Kawasaki disease. Heart 1997; 78(5): 517–8

    PubMed  CAS  Google Scholar 

  38. Checchia PA, Pahl E, Shaddy RE, et al. Cardiac transplantation for Kawasaki disease. Pediatrics 1997; 100(4): 695–9

    Article  PubMed  CAS  Google Scholar 

  39. Furukawa S, Matsubara T, Umezawa Y, et al. Pentoxifylline and intravenous gamma globulin combination therapy for acute Kawasaki disease. Eur J Pediatr 1994; 153: 663–7

    Article  PubMed  CAS  Google Scholar 

  40. Westphalen MA, McGrath MA, Kelly W, et al. Kawasaki disease with severe peripheral ischemia: treatment with prostaglandin E1 infusion. J Pediatr 1988; 112: 431–3

    Article  PubMed  CAS  Google Scholar 

  41. Tomita S, Chung K, Mas M, et al. Peripheral gangrene associated with Kawasaki disease. Clin Infect Dis 1992; 14(1): 121–6

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Delane Shingadia.

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Shingadia, D., Shulman, S.T. New Perspectives in the Drug Treatment of Kawasaki Disease. Pediatr-Drugs 1, 291–297 (1999). https://doi.org/10.2165/00128072-199901040-00005

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