Corticosteroid therapy for primary treatment of Kawasaki disease - weight of evidence: a meta-analysis and systematic review of the literature.
OBJECTIVE
Corticosteroids are the treatment of choice in most forms of vasculitis. However, their role in the primary treatment of Kawasaki disease (KD) is controversial. Our aim was to conduct a meta-analysis to assess the clinical course and coronary artery outcome of adding corticosteroids to standard therapy [intravenous immunoglobulin (IVIG) + aspirin] in patients with acute KD.


METHODS
We included randomised trials comparing the addition of corticosteroids to conventional primary therapy for Kawasaki disease.


RESULTS
A total of four studies were identified, which included 447 patients. The meta-analysis revealed a significant reduction in re-treatments with IVIG in patients receiving corticosteroid plus standard therapy compared with standard therapy alone [odds ratio (OR) 0.48; 95% confidence interval (CI): 0.24- 0.95]. There was however no significant reduction in the incidence of coronary artery aneurysms among patients who received corticosteroid therapy plus standard therapy, compared with standard therapy alone for either up to a month (OR 0.74; 95% CI: 0.23-2.40) or over one month ([OR 0.74; 95% CI: 0.37-1.51). Similarly no significant differences between treatment groups were noted in incidence of adverse events (OR 0.81; 95% CI: 0.05-0.88).


CONCLUSIONS
The inclusion of corticosteroids in regimens for the initial treatment of Kawasaki disease decreased rates of re-treatment with intravenous immunoglobulin. However the addition of corticosteroids to standard therapy did not decrease the incidence of coronary aneurysms or adverse events.
Athappan
Ganesh
G
Caritas St Elizabeth Medical Centre, Tufts School of Medicine, Boston, USA. ganeshathappan@gmail.com
Gale
Seth
S
Ponniah
Thirumalaikolundusubramanian
T
D001241:Aspirin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003323:Coronary Aneurysm / Q000209:etiology / Q000517:prevention & control; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000188:drug therapy*
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D001241:Aspirin
Pathol Int. 2001 Apr;51(4):257-63
11350607
Am Fam Physician. 1999 Jun;59(11):3093-102, 3107-8
10392592
J Pediatr. 1999 Oct;135(4):411-3
10518072
Pediatrics. 1979 Feb;63(2):175-9
440805
J Pediatr. 2003 Sep;143(3):363-7
14517521
Pediatr Int. 2001 Jun;43(3):211-7
11380911
N Engl J Med. 2007 Feb 15;356(7):663-75
17301297
J Pediatr. 1999 Oct;135(4):465-9
10518080
J Pediatr. 2006 Sep;149(3):336-341
16939743
Cleve Clin J Med. 2002;69 Suppl 2:SII69-78
12086269
Jpn Circ J. 1982 Nov;46(11):1239-42
7131714
Circ J. 2007 Jul;71(7):1052-9
17587710
J Pediatr. 2003 Jun;142(6):611-6
12838187
Circulation. 2004 Oct 26;110(17):2747-71
15505111
Pediatrics. 2005 Oct;116(4):989-95
16199713
Circulation. 1993 May;87(5):1776-80
8491037
BMJ. 1997 Aug 9;315(7104):322-3
9270443
J Pediatr. 1996 Jan;128(1):146-9
8551407