Steroid treatment for Kawasaki disease

Article Outline

• Copyright

The role of the corticosteroids in the treatment of Kawasaki disease has been controversial. For years, as a result of a single uncontrolled study, it was widely believed that corticosteroids were not useful and might even be deleterious in patients with Kawasaki disease. In that time, intravenous immunoglobulin (IVI6) became established as the treatment of choice through the results of randomized clinical trials. More recently, there have been anecdotal reports of successful treatment of Kawasaki disease with corticosteroids, particularly in refractory cases.

Inoue et al report on the results of a multi-center prospective randomized trial of corticosteroids in the primary therapy for Kawasaki disease. In this study, patients were randomized to IVI6 alone or IV16 plus corticosteroids. They report that the combination of IVI6 and corticosteroids resulted in a better outcome.

In an editorial, Burns urges some caution in applying the results of this study. She reminds us that one difficulty in studying new treatments for Kawasaki disease is the fact that IVI6 plus aspirin, in the doses used in the United States, is already a very effective therapy. Demonstrating improvement over an already effective therapy can be difficult and requires a very large sample size. She urges support for studies that would identify patients who are less likely to have successful treatment with IVI6. It is this patient group that would benefit most from newer therapies.