What is the role of corticosteroids in the treatment of Kawasaki disease?

Updated: Jul 29, 2018
  • Author: Tina K Sosa, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

In addition to their use in treatment of IVIG-resistant KD, corticosteroids have been proposed as part of primary therapy. This indication is controversial, however. Research results have been inconsistent, as follows:

  • In a multicenter prospective randomized trial in Japan, the combination of corticosteroids and IVIG significantly decreased coronary artery abnormalities, duration of fever, CRP levels, and initial treatment failure. [78]  The RAISE trial, conducted in Japan, also had similar findings. [79]

  • A randomized trial in the United States in which a single pulsed dose of methylprednisolone (30 mg/kg) was added to conventional therapy saw a reduction in the ESR at 1 week, but no difference in coronary artery abnormalities [80]

  • In a meta-analysis of 4 studies and 447 patients, Athappan et al concluded that the addition of steroids to standard therapy with IVIG and aspirin decreased the rate of re-treatment but did not decrease the incidence of coronary aneurysms or adverse events. [81]

  • Chen et al reviewed 16 studies that included 2746 patients and found that the rate of coronary artery abnormalities was significantly lower in the corticosteroids plus IVIG group than in the IVIG therapy alone group. The benefit was only found in the group using corticosteroids plus IVIG for the prevention of coronary artery abnormality, and not in the group using the treatment as rescue therapy. The greatest benefit was also seen in patients predicted to be at high risk of IVIG resistance. [82, 83]


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