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Steroids for Children with Kawasaki Disease?

Giving children with Kawasaki disease a pulse of methylprednisolone did not improve treatment outcome.

Despite receiving high-dose intravenous immune globulin (IVIG) within the first 10 days of illness, approximately 5% of children with Kawasaki disease (KD) develop coronary aneurysms. Previous studies, all with design limitations, have suggested that steroids as an adjunct to IVIG may improve the prognosis (see Journal Watch Infectious Diseases Nov 8 2006). Now, researchers have conducted a multicenter, randomized, double-blind, placebo-controlled trial to shed light on this issue. In this trial, 199 children with KD and fever duration 10 days received IVIG 2 g/kg with aspirin. (Nonresponding patients with prolonged fever were given additional doses of IVIG.) In addition, half received a single pulse of methylprednisolone (MP) 30 mg/kg, and half got placebo.

At 1 week and 5 weeks after randomization, body-surface–adjusted diameters of the right coronary artery and the left anterior descending coronary artery were similar between groups. At both intervals, the proportion of patients with coronary abnormalities was also similar between groups. Erythrocyte sedimentation rates fell more quickly in the MP group than in the placebo group, and initial hospitalizations were shorter, but the total number of hospital-days (including readmissions) was similar. Among the children who required retreatment with IVIG because of persistent fever, MP recipients fared better than placebo recipients, but this was not a planned outcome measure.

Comment: Methylprednisolone was not beneficial in the overall group but might provide benefit for a subgroup with higher risk for coronary-artery abnormalities. Although other studies have been done on MP in KD, this trial should currently be considered the definitive one because of its excellent analytic methods.

— Robert S. Baltimore, MD

Published in Journal Watch Infectious Diseases 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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