Corticosteroids for the treatment of Kawasaki disease in children

Wardle, Andrew J; Connolly, Georgia May; Seager, Matthew; Tulloh, Robert

doi:10.1002/14651858.cd011188.pub2

Cited by 80 publications

(66 citation statements)

References 44 publications

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“…However, IVIG resistance occurs in up to 20%–40% of unselected cases and is associated with increased coronary complication rates 1 10. Recent studies and meta-analyses of all published studies have suggested that addition of corticosteroids to IVIG reduces the risk of CAA, particularly in high-risk patients 1 10 11. However, there is currently no reliable method to predict which patients are at risk of CAA and thus require additional treatment, as scoring systems that predict IVIG non-response in Japan have not been reliable in studies in the UK and North America.…”

Section: Introductionmentioning

confidence: 99%

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

et al. 2018

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“…Glucocorticoids reduce the rates of CAA development when used in KD patients at high risk of being resistant to IVIG treatment (41,42). Verdoni and colleagues (7) reported a high rate of IVIG resistance in KD patients who presented during the COVID‐19 pandemic, as compared to that in a historical cohort of KD patients, which may suggest a role for glucocorticoids in MIS‐C.…”

Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

Henderson

Canna

Friedman

et al. 2020

Arthritis & Rheumatology

423

613

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Objective To provide guidance on the management of multisystem inflammatory syndrome in children (MIS‐C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID‐19), the acute, infectious phase of SARS–CoV‐2 infection. Methods A multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS‐C associated with SARS–CoV‐2 and hyperinflammation in COVID‐19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS‐C and hyperinflammation in COVID‐19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9‐point scale was used to determine the appropriateness of each statement (median scores of 1–3 for inappropriate, 4–6 for uncertain, and 7–9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting. Results The ACR task force approved a total of 128 guidance statements addressing the management of MIS‐C and hyperinflammation in pediatric COVID‐19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS‐C. Conclusion Our understanding of SARS–CoV‐2–related syndromes in the pediatric population continues to evolve. The guidance provided in this “living document” reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.

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“…Other treatment options that could be considered are use of corticosteroids. A cochrane review of 7 trials showed benefits of reducing cardiac complications by using steroids as adjunct therapy to IVIG early in the course of illness [ 14 ]. Use of steroids alone without IVIG has not been studied.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania

Noorani

Lakhani

2018

BMC Pediatr

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BackgroundKawasaki disease is a common childhood vasculitis which may result in cardiovascular morbidity if not adequately treated. Its epidemiology in the African region is not well described. Its features may mimic other childhood infections and hemoglobinopathies and it is rarely diagnosed in the East African region. These are the first reports of this disease from Tanzania.Case presentationWe present two cases of complete Kawasaki disease seen over a 2 year period and diagnosed as per the criteria defined by the American Heart Association. One child was and infant and the other a 3 year old. Both of them presented with a prolonged fever and mucocutaneous findings. None of the children developed coronary artery aneurysms. One was treated with aspirin alone and the other with both aspirin and intravenous immunoglobulin. Both children had complete recovery and did not have any cardiovascular sequelae.ConclusionKawasaki disease may be more common in the East African region than previously thought. It should be considered as a differential diagnosis in children who present with a prolonged fever of greater than 5 days and mucocutaneous findings. More awareness about this condition, its epidemiology, diagnosis and management are required in order to prevent the cardiovascular morbidity associated with it.

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Corticosteroids for the treatment of Kawasaki disease in children

Cited by 80 publications

References 44 publications

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania

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