Corticosteroid Therapy for Primary Treatment of Kawasaki Disease - Weight of Evidence : a Meta-Analysis and Systematic Review of the Literature : Cardiovascular Topics

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; 95confidence 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; 95CI 0.23-2.40) or over one month ([OR 0.74; 95CI 0.37-1.51). Similarly no significant differences between treatment groups were noted in incidence of adverse events (OR 0.81; 95CI 0.05-0.88). Conclusion: 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