Clarithromycin Plus Intravenous Immunoglobulin Therapy Can Reduce the Relapse Rate of Kawasaki Disease: A Phase 2, Open‐Label, Randomized Control Study

Abstract

BackgroundWe previously reported that biofilms and innate immunity contribute to the pathogenesis of Kawasaki disease. Therefore, we aimed to assess the efficacy of clarithromycin, an antibiofilm agent, in patients with Kawasaki disease.Methods and ResultsWe conducted an open‐label, multicenter, randomized, phase 2 trial at 8 hospitals in Japan. Eligible patients included children aged between 4 months and 5 years who were enrolled between days 4 and 8 of illness. Participants were randomly allocated to receive either intravenous immunoglobulin (IVIG) or IVIG plus clarithromycin. The primary end point was the duration of fever after the initiation of IVIG treatment. Eighty‐one eligible patients were randomized. The duration of the fever did not differ between the 2 groups (mean±SD, 34.3±32.4 and 31.1±31.1 hours in the IVIG plus clarithromycin group and the IVIG group, respectively [P=0.66]). The relapse rate of patients in the IVIG plus clarithromycin group was significantly lower than that in the IVIG group (12.5% versus 30.8%, P=0.046). No serious adverse events occurred during the study period. In a post hoc analysis, the patients in the IVIG plus clarithromycin group required significantly shorter mean lengths of hospital stays than those in the IVIG group (8.9 days versus 10.3 days, P=0.049).ConclusionsAlthough IVIG plus clarithromycin therapy failed to shorten the duration of fever, it reduced the relapse rate and shortened the duration of hospitalization in patients with Kawasaki disease.Clinical Trial RegistrationURL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000015437.

Neutrophil-to-lymphocyte ratio and scoring system for predicting coronary artery lesions of Kawasaki disease

“…Echocardiography was performed in acute stage, and CAL were defined according to the Japanese Ministry of Health criteria: an internal lumen diameter greater than 3.0 mm in children of < 5 years of age or greater than 4.0 mm in children of ≥ 5 years of age or an internal diameter at least 1.5 times larger than the diameter of the adjacent segment, or if the morphology of the coronary lumen was obviously irregular, or a z-score ≥ 2.5 [3,29]. We classified the patients into two groups: patients with CAL and patients without CAL [30].…”

Neurological involvement, immune response, and biomarkers in Kawasaki disease along with its pathogenesis, therapeutic and diagnostic updates

“…Clarithromycin may thus be beneficial in treating people with the acute form of KD as well as their siblings to stop the disease from spreading to them. 37 There were fewer refractory KD patients in the combination therapy cluster than in the IV IG alone cluster in a trial of two groups, one receiving an anti-TNF drug along with IV IG, and the other receiving IV IG alone. Patients with KD who received combination therapy had better results, shorter hospital stays and fever durations, and less arterial dilatation.…”

Medicamentos versátiles: buscando balas mágicas

“…54,55 Una hipótesis sustenta que la periodontitis producida por bacterias anaeróbicas es importante en la artritis reumatoide; sin embargo, la atribución de una causa estrictamente infecciosa a una enfermedad autoinmune aún es controversial. 56 Recientemente se publicó la efi cacia de la claritromicina junto con la inmunoglobulina endovenosa en el tratamiento de la enfermedad de Kawasaki. Moléculas como FK-565 tienen similitud estructural con los patrones moleculares asociados con microbios (MAMP's) y poseen tropismo para desarrollar una respuesta infl amatoria en los vasos sanguíneos, incluyendo arterias coronarias.…”