Use of corticosteroids during acute phase of Kawasaki disease

Abstract

In spite of initial intravenous immunoglobulin (IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, have been considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids - the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.

Prediction of unresponsiveness to second intravenous immunoglobulin treatment in patients with Kawasaki disease refractory to initial treatment

“…Investigations regarding the efficacy of exclusive administration of corticosteroids as the second-line treatment have shown no superior protective effect for coronary artery lesions relative to additional IVIG administration15162425). In one study, the combination of IVIG and oral prednisolone was recommended as a second-line treatment26). However, the addition of methyl prednisolone to the second-line IVIG treatment regimen was not significantly advantageous in this study.…”

Kawasaki disease: etiopathogenesis and novel treatment strategies

“…They reported higher incidence of sinus bradycardia and hyperglycemia in patients treated with IVMP compared to those treated with second dose of IVIG. Although these adverse effects were only transient, but indicate the need for monitoring of patients on steroid infusion [75]. Overall IVMP is considered safe as an adjuvant treatment to IVIG alone or along with aspirin [14].…”

Experience in the diagnosis and treatment of Kawasaki disease in the Saint-Petersburg State Pediatric Medical University Clinic and Saint Petersburg City Children’s Hospital One

“…Так, в США при БК наиболее широко применяются высокие дозы аспирина (80-100 мг/кг), в Японии же стандартной терапи-ей являются более низкие дозы (30-50 мг/кг) [18]. Одному пациенту, резистентному к терапии ВВИГ и аспирином, проведена терапия ГК, которая может быть назначена как во второй линии, так и в более ранние сроки в группах вы-сокого риска, в том числе у детей первого года жизни [27]. Все чаще для лечения резистентных случаев используется генно-инженерная иммунобиологическая терапия, в пер-вую очередь инфликсимаб [28].…”