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Use of Adjunctive Therapy in Acute Kawasaki Disease in Latin America
Brenda Fortuna-Reyna1, Emelia V Bainto2,3, Rolando Ulloa-Gutierrez4,5
1Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico.
Insights
This study analyzed Kawasaki disease (KD) treatments in Latin America, finding IVIG resistance often treated with steroids. Limited use of biologics like infliximab was noted, with adjunctive therapy linked to specific patient markers.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Cardiology
Background:
- Kawasaki disease (KD) is a critical pediatric illness affecting coronary arteries.
- Intravenous immunoglobulin (IVIG) is the standard initial therapy for KD.
- Understanding adjunctive therapy patterns is crucial for improving KD management.
Purpose of the Study:
- To characterize the utilization of adjunctive therapies in Kawasaki disease patients across Latin America.
- To identify patterns and trends in the use of treatments beyond initial IVIG.
Main Methods:
- A retrospective analysis of 1,418 patients diagnosed with KD in Latin America (2009-2017).
- Data collected from the Latin American KD Network (REKAMLATINA).
- Comparison of patient demographics and treatment strategies between those receiving single-dose IVIG versus those receiving additional therapies.
Main Results:
- 266 out of 1,418 patients received adjunctive therapy beyond initial IVIG.
- Steroids were the most common adjunctive treatment for IVIG-resistance, followed by additional IVIG doses.
- Biologic agents like infliximab were used infrequently.
- Adjunctive therapy was associated with lower platelet counts, lower albumin levels, and higher coronary artery Z scores.
Conclusions:
- This study provides the first overview of adjunctive therapies for KD in Latin America.
- While IVIG remains primary, steroids are frequently used for resistance, with limited use of biologics.
- Further research is needed to explore therapeutic barriers in acute KD within the region.
Abstract:
Objective: To characterize the use of adjunctive therapy in Kawasaki disease (KD) in Latin America. Methods: The study included 1,418 patients from the Latin American KD Network (REKAMLATINA) treated for KD between January 1, 2009, and May 31, 2017. Results: Of these patients, 1,152 received only a single dose of IVIG, and 266 received additional treatment. Age at onset was similar in both groups (median 2 vs. 2.2 years, respectively). The majority of patients were male (58 vs. 63.9%) and were hospitalized with the first 10 days of fever (85.1 vs. 84.2%). The most common adjunctive therapy administered was steroids for IVIG-resistance, followed by additional doses of IVIG. The use of biologics such as infliximab was limited. KD patients who received adjunctive therapy were more likely to have a lower platelet count and albumin level as well as a higher Z score of the coronary arteries. Conclusion: This is the first report of adjunctive therapies for KD across Latin America. IVIG continues to be the initial and resistance treatment, however, steroids are also used and to a lesser extent, biological therapy such as infliximab. Future studies should address the barriers to therapy in children with acute KD throughout Latin America.
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