The use of glucocorticoids in immunoglobulin-resistant Kawasaki disease

The treatment of intravenous immunoglobulin-resistant Kawasaki disease (IVIGRKD) is still controversial, and few studies investigate using glucocorticoids (GCs) alone as rescue therapy for Kawasaki Disease (KD) patients. This study aimed to investigate the efficacy of using GCs alone as rescue therapy in IVIGRKD patients and to further explore the appropriate GCs dosage. We enrolled 210 IVIGRKD diagnosed in our hospital and conducted a cohort analysis. Patients were divided into the intravenous immunoglobulin (IVIG) group, IVIG + GCs group, and the GCs group. The GCs group was further divided into GCs A group(10-15 mg/kg/d) and GCs B group(1-4 mg/kg/d). Clinical outcomes and changes in coronary arteries after the treatment during a one-year period were observed. Propensity-score matching and logistic regression analyses were used to make the comparison. After propensity-score matching, the therapeutic response rate in the GCs group was significantly higher than that in the IVIG group (91.1% vs. 69.6%, P = 0.004). And there was no significant difference between the IVIG group and IVIG + GCs group and between the GCs group and IVIG + GCs group. We further compared various doses of GCs (10–15 mg/kg/d and 1–4 mg/kg/d) and didn’t find a significant difference. After logistic regression analysis, it was found that the therapeutic response rate in the GCs group was significantly higher than in the IVIG group (P = 0.001, OR = 2.24, 95% CI 1.37–3.67). Additionally, the therapeutic response rate was significantly higher in the IVIG + GCs group than in the IVIG group (P = 0.01, OR = 4.73, 95% CI: 1.40-16.02). However, there was no significant difference between the GCs and IVIG + GCs groups. Different doses of GCs (10–15 mg/kg/d and 1–4 mg/kg/d) were also not significantly correlated with the treatment efficiency. There was no significant difference in preventing coronary artery lesions (CALs) between different groups. Single-GCs therapy is a viable option for patients who do not respond to IVIG, and a dosage of 1–4 mg/kg/d of GCs demonstrated comparable efficacy to higher-dose regimens and may represent an effective treatment option for IVIGRKD patients.