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Yonsei Medical Journal ; : 714-718, 2008.
Artigo em Inglês | WPRIM | ID: wpr-153707

RESUMO

PURPOSE: The aim of this study was to evaluate the efficacy of low-dose oral methotrexate (MTX) as a treatment for patients with Kawasaki disease (KD) which was resistant to intravenous immunoglobulin (IVIG). PATIENTS AND METHODS: The patients who had persistent or recrudescent fever after treatment with IVIG were subsequently treated with low-dose oral MTX [10mg/body surface area (BSA)] once weekly. RESULTS: Seventeen patients developed persistent or recrudescent fever after treatment of KD with IVIG and were consequently given MTX. The proportion of children with coronary artery lesions (CALs) was 76%. The median value of maximum body temperatures decreased significantly within 24 hours of MTX therapy (38.6degrees C vs. 37.0degrees C, p < 0.001). The median CRP (C-reactive protein) level was found to be significantly lower 1 week after administering the first dose of MTX (8.9mg/dL vs. 1.2mg/dL, p < 0.001). The median duration of fever before MTX treatment was shorter in CALs (-) group than in CALs (+) group (7 days vs. 10 days, p = 0.023). No adverse effects of MTX were observed. CONCLUSION: MTX treatment for IVIG-resistant KD resulted in quick resolution of fever and rapid improvement of inflammation markers without causing any adverse effects. MTX therapy should further be assessed in a multicenter, placebo-blinded trial to evaluate whether it also improves coronary artery outcome.


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resistência a Medicamentos , Imunoglobulinas Intravenosas/uso terapêutico , Metotrexato/administração & dosagem , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Resultado do Tratamento
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