Presented by Jasmine Weiss, MD PGY-1
- 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
- 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
- Dosing of Methylprednisolone; didn’t consider other regimen’s
- Site of Temperature not standardized
- Data not collected beyond 5 weeks
- 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
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.