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First-line corticosteroids for Kawasaki disease: Pulse versus multiple dose
Joseph Y Abrams1, Ryusuke Ae1,2, Ryan A Maddox1
1Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Summary
Multiple-dose corticosteroids combined with IVIG significantly reduce coronary artery abnormalities and treatment failure in Kawasaki disease (KD) patients compared to pulse corticosteroid regimens. This approach offers improved clinical outcomes for KD management.
Area of Science:
- Pediatric Cardiology
- Immunology
- Rheumatology
Background:
- Kawasaki disease (KD) poses a risk of severe coronary artery abnormalities (CAAs).
- Corticosteroids combined with intravenous immunoglobulin (IVIG) may mitigate KD complications.
- Discrepant study results may stem from varied corticosteroid regimens (pulse vs. multiple-dose).
Purpose of the Study:
- To compare the efficacy of pulse versus multiple-dose corticosteroid regimens in preventing CAAs and treatment failure in KD patients.
- To analyze adjusted outcomes based on different corticosteroid administration strategies.
Main Methods:
- Utilized data from Japanese nationwide KD surveys (2011-2016).
- Included KD patients without initial CAAs, treated with either pulse or multiple-dose corticosteroids.
- Compared subsequent CAAs and treatment failure rates, calculating adjusted odds ratios.
Main Results:
- Multiple-dose corticosteroid treatment (4,817 patients) showed lower CAA rates (5.5%) versus pulse treatment (8.3%).
- Treatment failure was significantly lower with multiple-dose regimens (21.4%) compared to pulse (41.6%).
- Adjusted analyses confirmed multiple-dose treatment's protective effect against CAAs (OR: 0.67) and treatment failure (OR: 0.39).
Conclusions:
- Multiple-dose corticosteroid combination therapy significantly improves outcomes in KD patients compared to pulse therapy.
- This regimen is likely beneficial for patients at higher risk of treatment failure or developing CAAs.
- Recommends multiple-dose corticosteroids alongside IVIG for enhanced clinical benefit in KD management.
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