title: Corticosteroid therapy for primary treatment of Kawasaki disease - weight of evidence: a meta-analysis and systematic review of the literature.
abstract: 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.
authors.affiliation: Caritas St Elizabeth Medical Centre, Tufts School of Medicine, Boston, USA. ganeshathappan@gmail.com
authors.forename: Ganesh
authors.initials: G
authors.lastname: Athappan
authors.forename: Seth
authors.initials: S
authors.lastname: Gale
authors.forename: Thirumalaikolundusubramanian
authors.initials: T
authors.lastname: Ponniah
mesh_terms: 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*
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D001241:Aspirin
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