Combination of prednisolone and cyclosporine A as third-line therapy for refractory Kawasaki disease

BACKGROUND: The selection of drugs as third-line therapy for patients with Kawasaki disease (KD) who are resistant to second-line therapy remains controversial.METHODS: We reviewed the medical records of 354 patients (216 males/137 females) with KD who were treated in our department from July 2003 to January 2016. The age range was 1 month to 10 years, and the median age was 2 years and 1 month. A combination of 2 g/kg intravenous immunoglobulin (IVIG) plus 30 mg/kg of aspirin was used as first-line therapy. Patients who were refractory to the first-line therapy were administered 2 mg/kg of prednisolone (PSL) in combination with IVIG. Five patients who were refractory to the second-line therapy were treated with cyclosporine A (CsA) combined with PSL as the third-line therapy.RESULTS: All five patients immediately responded to the third-line therapy. One of the five patients showed a transient dilatation of the coronary artery that regressed to its normal size by the 60th day of illness.CONCLUSIONS: We suggest that the combination of CsA and steroids might be a promising therapeutic strategy for refractory KD.