Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial

Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial

“…[14][15][16][17][18][19] A meta-analysis of these studies concluded that the addition of corticosteroids to intravenous immunoglobulin resulted in fewer coronary artery abnormalities than with treatment with intravenous immunoglobulin alone (OR 0·3, 95% CI 0·18-0·5). 20 However, heterogeneity in patient selection and treatment protocols severely limits application to our patient population.…”

“…20 However, heterogeneity in patient selection and treatment protocols severely limits application to our patient population. Three studies assessed 3-5 days of intravenous methylprednisolone (2 mg/kg per day) followed by a 2-4 week oral taper, 14,16,19 whereas the remaining three studies used a single pulse of intravenous methylprednisolone (30 mg/kg per day). 15,17,18 Five studies excluded patients with coronary artery abnormalities at baseline, [14][15][16]18,19 and two studies used Japanese scoring systems to select patients likely to be …”

“…Table 5: Change in laboratory data from baseline at 24 h after completion of intravenous immunoglobulin and at week 2 and week 5 after randomisation by study group intravenous immunoglobulin-resistant. 18,19 Unfortunately, these scoring systems have not successfully identifi ed US children at higher risk of treatment resistance, and clinicians are reluctant to adopt non-selective steroid therapy for all Kawasaki disease patients since most patients are not at risk for sequelae. 2,21 A North American trial assessed the eff ect of addition of a single dose of intravenous methylprednisolone (30 mg per kg) to standard intravenous immunoglobulin and aspirin therapy but, because of the overall low rate of coronary artery abnormalities, was unable to show a signifi cant diff erence in the primary endpoint of the mean Z max score for the right coronary artery and left anterior descending coronary artery combined between groups.…”

Immunoglobulin Resistance in Kawasaki Disease

“…30 Steroid therapy has been recommended, more so in the immunoglobulin-resistant phenotype, to reduce the incidence of coronary artery aneurysms. [38][39][40][41][42] Infliximab, a monoclonal antibody against tumor necrosis factor a associated with signaling pathways of inflammation in Kawasaki disease, 43 has been reported to control fever in immunoglobulin-resistant children. 44 The immunoglobulin-resistant phenotype in the patients in the current study was similar to that described in previously published literature with a similar prevalence, and there were associations with a significantly longer duration of fever and a higher coronary artery involvement, signifying a hyperinflammatory status in resistant children.…”

Clinical Manifestation, Diagnostics and Treatment of Kawasaki Disease: Known Data and Unsolved Questions

“…Публикация в 2012 г. статьи Kobayashi и соавт. [58] вновь инициировала обсуждение вопроса о роли глюкокортикоидов в терапии больных с СК. В результате рандомизированного контролируемого исследования авторы показали высокую эффективность их назначе-ния в сочетании с ИГВВ и ацетилсалициловой кислотой в качестве стартовой терапии у больных с тяжелым вариантом СК.…”