Backgrounds and Objectives: RAISE protocol demonstrated that IVIG plus prednisolone (PSL) therapy reduced the incidence of coronary artery abnormalities (CAAs) in children with high risk of refractory Kawasaki disease (KD). However, this protocol has longer hospital stay because PSL is tapered over the next 15 days when CRP was under 5mg/L. We proposed modified RAISE protocol which PSL is tapered over 9 days. The aim of this study was to evaluate clinical utility of modified RAISE protocol.
Methods: This is a retrospective study to evaluate clinical data from KD between May, 2012 and August, 2014. Composite outcomes included incidence of relapse and coronary arterial abnormalities. Using Kobayashi score, children were divided into high and low risk group.
Results: We enrolled 36 KD patients with high risk group in total 147 patients with KD. Median of age was 33 months (range 2-83 months), 13 males. Median days of illness were 4.0 (range 2-7) and Kobayashi score was 6.0 (range 5-9). Overall, 31 children (86.1%) were responders, whereas 5 children were non-responders (resistance; 1 (2.8%) relapse; 4 (11.1%)). Among 5 non-responders, 4 patients received methylprednisolone pulse therapy (mPSL) and the remaining one patient administrated two times mPSL and infliximab. During follow-up (1-29 months), 3 children (8.3%) had CAAs (dilatation: 3 patients). Modified RAISE protocol was not inferior to conventional RAISE protocol (CAAs 3.3%, p=0.68, responder 84.3%, p=1.0, resistance 5.0%, p=0.92, relapse 10.7%, p= 0.66).
Conclusions: Clinical safety and efficacy of modified RAISE protocol (3days х3) were similar to conventional RASIE protocol(5days х3).