Related Experiment Video

Updated: May 20, 2025

Assessment of Antibody-based Drugs Effects on Murine Bone Marrow and Peritoneal Macrophage Activation
10:35

Assessment of Antibody-based Drugs Effects on Murine Bone Marrow and Peritoneal Macrophage Activation

Published on: December 26, 2017

8.2K

The Comparative Effectiveness of Intravenous Immunoglobulin and Corticosteroids in Kawasaki Disease: A Nationwide

Sujin Lee1,2, Seeun Choi1, Kiyon Rhew1

  • 1College of Pharmacy, Dongduk Women's University, Seoul 02748, Republic of Korea.

Journal of Clinical Medicine
|March 27, 2025
PubMed

Insights

Corticosteroids (CSs) combined with aspirin are linked to a higher risk of coronary artery aneurysm (CAA) in children with Kawasaki disease (KD) compared to intravenous immunoglobulin (IVIg) and aspirin. IVIg remains the preferred first-line treatment for KD.

Area of Science:

  • Pediatric Rheumatology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Kawasaki disease (KD) is a critical pediatric vasculitis, with coronary artery aneurysm (CAA) as its most severe complication.
  • Intravenous immunoglobulin (IVIg) plus aspirin (ASA) is the standard KD treatment, but concerns drive interest in corticosteroids (CSs) as alternatives.
  • This study evaluates the comparative effectiveness of IVIg and CSs in managing pediatric KD.

Purpose of the Study:

  • To compare the incidence of coronary artery aneurysm (CAA) in pediatric patients with Kawasaki disease (KD) treated with corticosteroids (CSs) versus intravenous immunoglobulin (IVIg).
  • To assess secondary outcomes, including other cardiovascular complications in KD patients receiving CSs compared to IVIg.
  • To inform first-line treatment strategies for Kawasaki disease.

Main Methods:

  • Retrospective analysis of South Korean Health Insurance Review and Assessment Service (HIRA) data (2017-2020).
  • Inclusion of pediatric patients under five diagnosed with KD and treated with either IVIg + ASA or CSs + ASA.
  • Application of propensity score weighting and Cox proportional hazards models to compare outcomes, focusing on CAA incidence and cardiovascular complications.

Main Results:

  • The incidence of coronary artery aneurysm (CAA) was significantly higher in the corticosteroid (CSs) group (6.72%) compared to the intravenous immunoglobulin (IVIg) group (1.86%) (HR = 3.70; 95% CI: 1.96-6.97; p < 0.0001).
  • Cardiovascular complications were also more frequent in the CSs group (HR = 2.87; 95% CI: 1.96-6.97; p < 0.0001).
  • Propensity score weighting adjusted for potential confounding factors, strengthening the observed associations.

Conclusions:

  • Corticosteroids (CSs) plus aspirin are associated with an increased risk of coronary artery aneurysm (CAA) and cardiovascular complications in pediatric Kawasaki disease (KD) patients compared to IVIg plus aspirin.
  • CSs should not replace IVIg as the first-line therapy for KD, although they may serve as an adjunct for IVIg-resistant cases.
  • Further research into alternative strategies, such as reduced-dose IVIg with adjunctive therapies, is warranted for optimal KD management.

Keywords:
Kawasaki diseasecorticosteroidimmunoglobulinpediatricvasculitis

More Related Videos

Knee Arthrocentesis in Adults04:41

Knee Arthrocentesis in Adults

Published on: February 25, 2022

7.2K
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

16.8K

Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids

Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
92
Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
83
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
119
Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
106