A multicenter prospective randomized trial of corticosteroids in primary therapy for Kawasaki disease: Clinical course and coronary artery outcome
ABSTRACT To investigate the role of corticosteroids in the initial treatment of Kawasaki disease (KD).
Between September 2000 and March 2005, we randomly assigned 178 KD patients from 12 hospitals to either an intravenous immunoglobulin (IVIG) group (n = 88; 1 g/kg for 2 consecutive days) or an IVIG plus corticosteroid (IVIG+PSL) group (n = 90). The primary endpoint was coronary artery abnormality (CAA) before a 1-month echocardiographic assessment. Secondary endpoints included duration of fever, time to normalization of serum C-reactive protein (CRP), and initial treatment failure requiring additional therapy. Analyses were based on intention to treat.
Baseline characteristics of groups were similar. Fewer IVIG+PSL patients than IVIG patients had a CAA before 1 month (2.2% vs 11.4%; P = .017). The duration of fever was shorter (P < .001) and CRP decreased more rapidly in the IVIG+PSL group than in the IVIG group (P = .001). Moreover, initial treatment failure was less frequent (5.6% vs 18.2%; P = .010) in the IVIG+PSL group. All patients assigned to the IVIG+PSL group completed treatment without major side effects.
A combination of corticosteroids and IVIG improved clinical course and coronary artery outcome without causing untoward effects in children with acute KD.
- SourceAvailable from: nmji.in
Article: Is it Kawasaki disease?[Show abstract] [Hide abstract]
ABSTRACT: Atypical cases of KD are common (up to 10% of the total) and the diagnosis should be considered without the full complement of diagnostic criteria. The risk of coronary dilation is high if IVIG is not given. Administration of IVIG is effective at preventing aneurysms, if given early. The high-risk groups for coronary artery disease are infants younger than 6 months of age and older children with very high platelet counts, high ESR and fever persisting for more than 2 weeks.Journal of Paediatrics and Child Health 11/2000; 36(5):506-8. DOI:10.1046/j.1440-1754.2000.00572.x · 1.19 Impact Factor
- American Journal Of Pathology 04/2002; 160(4):1311-1324. DOI:10.1016/S0002-9440(10)62558-8 · 4.60 Impact Factor
- Journal of Pediatrics 10/2006; 149(3):291-2. DOI:10.1016/j.jpeds.2006.07.016 · 3.74 Impact Factor