Practice Based Learning: Efficacy of Corticosteroids in the Primary Treatment of Kawasaki Disease

Jasmine Weiss, MD

Presented by Jasmine Weiss, MD PGY-1

Clinical Question

  • Should corticosteroids be used in the primary treatment of Kawasaki’s disease?

Corticosteroids as Primary Treatment? The Controversy:

  • Kawasaki Disease: The Effect of Treatment on Coronary Artery Involvement (Kato H. et. al 1979)
  • Prospective Study- comparing monotherapies (n=92)
  • Prednisolone, Aspirin, Cephalexin, Prednisolone + Aspirin Prednisolone + Warfarin
  • Coronary aneurysms were demonstrated in 11 (64.7%) of 17 cases of patients treated with Prednisolone

Conclusions & Limitations of Inoue, et al. (2006):

  • Addition of PSL+ IVIG significantly reduces the risk of:
    • CAA, Duration of fever
    • Normalization of CRP
    • Treatment Failure
  • Limitations:
    • Difference in IVIG standard Dosing
    • Definition of  Treatment Failure
    • Japan vs. US

Conclusions & Limitations of Newburger, et al. (2007):

  • Pulse dose Methylprednisolone did not significantly improve coronary artery outcomes – Not indicated routinely
  • In individuals refractory to IVIG treatment, CS decreased risk of coronary abnormalities and decreased hospital stay
  • Limitations:
    • Dosing of Methylprednisolone; didn’t consider other regimen’s
    • Site of Temperature not standardized
    • Data not collected beyond 5 weeks

Summary:

  • Different schools of thought whether or not corticosteroids should be used in primary treatment
  • Requires further investigation and can vary based on practice guidelines
  • Demonstrates some benefit overall for patients refractory to IVIG
  • Must also consider side effects of CS, determine if benefit outweigh the risk

References:

Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement. Pediatrics. 1979 Feb;63(2):175-9.

Inoue Y, Okada Y, Shinohara M, et al. A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: clinical course and coronary artery outcome. J Pediatr. 2006 Sep;149(3):336-341.

Newburger JW, et al. Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease. N Engl J Med. 2007 Feb 15;356(7):663-75.

Shinohara M, et al. Corticosteroids in the treatment of the acute phase of Kawasaki disease. J Pediatr. 1999 Oct;135(4):465-9.

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