Effect of corticosteroids in addition to intravenous gamma globulin therapy on serum cytokine levels in the acute phase of Kawasaki disease in children.
OBJECTIVE
The aim of this multicenter prospective and randomized study was to determine the effect of adding corticosteroids to intravenous gamma globulin (i.v.GG) therapy on serum cytokine levels, as well as to see its effect on the clinical course in children in the acute phase of Kawasaki disease (KD).


METHODS
Patients with KD (n=32) were randomized to receive either i.v.GG alone (G group) or i.v.GG plus corticosteroids (G+S group). The clinical course and cytokine responses between groups were compared.


RESULTS
The pretreatment serum levels of interleukin (IL)-2, IL-6, IL-8, and IL-10 were significantly higher in patients with KD than in healthy controls. Although i.v.GG alone failed to reduce cytokine concentrations within 24 hours of i.v.GG administration, corticosteroids plus i.v.GG reduced IL-2, IL-6, IL-8, and IL-10 levels. The levels of IL-2, IL-6, IL-8, and IL-10 within 24 hours after initiating i.v.GG therapy were significantly lower in the G+S group than in the G group. The duration of fever was shorter, and the C-reactive protein concentration decreased more quickly in the G+S group than in the G group.


CONCLUSIONS
These findings suggest that corticosteroids rapidly ameliorate symptoms by reducing cytokine levels in children with KD.
D000210:Acute-Phase Reaction / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood* / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D005719:gamma-Globulins / Q000008:administration & dosage* / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D005719:gamma-Globulins; D011239:Prednisolone