Pulsed Corticosteroids Provide No Further Advantage in Kawasaki Disease

Clinical trial performed by Harvard physicians showed no significant benefit of corticosteroids in controlling vasculitis associated with Kawasaki disease and long-term coronary complication. Randomized clinical trial revealed patients in the methylprednisolone group did have a shorter initial period of hospitalization (p=0.05) and, at week 1, a lower erythrocyte sedimentation rate (p=0.02), but the two groups had similar numbers of days spent in the hospital, numbers of days of fever, rates of re-treatment with immune globulin, and numbers of adverse events.
"Our data do not provide support for the addition of a single dose of pulsed intravenous methylprednisolone to conventional therapy in the routine primary treatment of Kawasaki disease" - Newburger's statement to HeartWire (Medscape Inc).

Kawasaki disease, an acute idiopathic self-limiting vasculitis that occurs in childhood is most common in Japan, although it affects children of all ethnic backgrounds. About 4000 cases of Kawasaki disease occur in the US each year, and the incidence is on the rise; In fact, it has replaced acute rheumatic fever as the leading cause of acquired heart disease in children in the US and Japan. Coronary artery aneurysms develop in 15% to 25% of untreated children and can lead, over time, to ischemic heart disease. American Heart Association advise long-term follow-up to monitor for coronary involvement in all cases of Kawasaki disease. Intravenous immune globulin therapy plus aspirin has been shown to blunt the acute inflammation and reduce the risk of coronary artery damage, with routine treatment cutting the rate of coronary artery aneurysms detectable on echo to around 5%.

Ref.:
1. Medscape News Feb 15, 2007
2. Newburger et al., Randomized Trial of Pulsed Corticosteroid Therapy for Primary Treatment of Kawasaki Disease - N Engl J Med 2007;356:663-675