Corticosteroids for Kawasaki Disease in Children

Summary

A Cochrane review [Abstract] 1 included 8 studies with a total of 1 877 children with Kawasaki disease. Seven studies investigated the use of corticosteroids in first-line treatment and 1 investigated second-line treatment after treatment-failure (IVIG-resistant Kawasaki disease). In 6 studies, all children were given intravenous immunoglobulin (IVIG) and aspirin and in 1 study IVIG, and the use of corticosteroids had to be the only difference in management between intervention and control arms. In the second-line treatment study corticosteroid was compared with IVIG+aspirin.

Corticosteroids reduced coronary artery abnormalities (OR 0.32, 95% CI 0.14 to 0.75, statistical heterogeneity I² = 63%; 8 studies, n=986), duration of fever (MD −1.34 days, 95% CI −2.24 to -0.45 days; statistical heterogeneity I² = 76%; 3 studies, n=290), time for laboratory parameters (erythrocyte sedimentation rate and CRP) to normalise (MD −2.80 days, 95% CI −4.38 to −1.22 days; 1 study, n=178) and length of hospital stay (MD −1.01 days, 95% CI −1.72 to −0.30 days; 2 studies, n=119). None of the studies reported long-term (> 1 year after disease onset) coronary morbidity. No serious adverse events attributable to corticosteroid use were recorded (6 studies, n=737; no events). From the 8 studies (n=1 075) no deaths were recorded within the observed study period.

Subgroup analysis showed first-line corticosteroid treatment was more effective at reducing coronary artery abnormalities compared to no corticosteroids, but this effect was not evident in the second-line treatment subgroup. Subgroup analysis suggested that with respect to coronary abnormality, there was a benefit of steroids taken over a prolonged course versus the potential for no benefit if steroids were given as a one-off dose; the greatest benefit was in children with high-risk scores versus those with low-risk scores, although both displayed benefit; and the greatest benefit was in children in Japan versus those in North America, but the use of different regimens may have contributed to the different outcomes in Japanese and American studies, and the studies completed in North America were both considered part of the lower-risk group and employed single-dose regimens.