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Treatment of Kawasaki Disease

These data do not support adding IV steroids to routine treatment.

Intravenous immune globulin (IVIG) plus aspirin reduces the risk for coronary artery disease in patients with uncomplicated, acute Kawasaki disease (KD). The use of steroids in patients with complicated disease has led to speculation that steroids should become part of routine therapy. In a U.S. multisite, double-blind, clinical trial, researchers randomized 199 patients with KD and fever for 10 days to receive a single pulsed dose of IV methylprednisolone (30 mg/kg) or placebo added to conventional therapy with IVIG (2 g/kg) and aspirin (80–100 mg/kg/day).

At week 1 and week 5, no differences were noted between groups in any measure of coronary disease, including changes in dimensions of the left anterior descending and right coronary arteries. However, compared with placebo recipients, patients who received IV steroids had shorter periods of initial hospitalization and a lower median erythrocyte sedimentation rate at week 1 (69 vs. 57 mm/hr). The total number of hospital days (including readmissions), days of fever, patients requiring retreatment with IVIG, and adverse events was similar in both groups.

Comment: As noted by the authors and an editorialist, these data do not support the addition of a single dose of IV steroids for primary treatment of uncomplicated KD. However, the duration of follow-up was short. Steroids possibly might further prevent the long-term development of coronary artery disease, but because IVIG reduces the rate of coronary-artery aneurysms detectable by echocardiography to between 3% and 5%, a much larger study would be needed to detect any additional benefit from steroids. In contrast with the results of this study, a randomized study of Japanese children with KD reported improved outcomes using a different IVIG and steroid regimen.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 14, 2007

Citation(s):

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

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• Medline abstract (Free)

Burns JC. The riddle of Kawasaki disease. N Engl J Med 2007 Feb 15; 356:659-61.

• Original article (Subscription may be required)
• Medline abstract (Free)