Corticosteroids Appear to Prevent Coronary Abnormalities in Kawasaki Disease
Addition of corticosteroids to initial intravenous immunoglobulin (IVIG) treatment appears to reduce the rate of coronary-artery abnormalities in high-risk patients with Kawasaki disease, according to a nationwide survey from Japan.
"Clinical trials in Japan have previously demonstrated that the initial use of corticosteroids in combination with the standard IVIG treatment was more effective in preventing development of coronary-artery abnormalities among select patients," said Dr. Ryusuke Ae of Jichi Medical University, in Tochigi, Japan, and the Centers for Disease Control and Prevention, in Atlanta.
"However, a multicenter, randomized trial in the United States did not reach the same conclusion," he told Reuters Health by email.
For the current study, Dr. Ae and colleagues used data derived from the 21st and 24th nationwide Kawasaki disease surveys in Japan to compare the effectiveness of standard treatment with IVIG and aspirin versus corticosteroids added to standard treatment in preventing coronary-artery abnormalities in patients with high-risk Kawasaki disease.
After applying selection criteria and matching steps to patients from 115 hospitals, 1,593 patients with Kawasaki disease in the combination-treatment group and the same number of controls in the standard-treatment group were selected for inclusion in 1,000 sample iterations of a logistic regression analysis.
The median number of patients who developed coronary-artery abnormalities was 47% lower in the combination-treatment group (4.6%) than in the standard-treatment group (8.8%), a significant reduction.
The median treatment-failure rate was also significantly lower with combination treatment (14.1%) than with standard treatment (21.7%), the researchers report in the Journal of the American Heart Association.
Secondary analyses that controlled for potential unmeasured confounding yielded similar results.study, along with others, supports the conclusion that coronary-artery complications can be reduced or prevented in many severe cases with early intensification of standard treatment, such as use of a combination of IVIG and corticosteroid.Corticosteroids should be used aggressively in the initial treatment for Kawasaki disease patients who are at risk for coronary aneurysms," said Dr. Miura, who was not involved in the new study. "Early administration of corticosteroids is also recommended as an additional treatment for those unresponsive to initial immunoglobulin therapy."