Shaojie Chen1, Ying Dong2, Marcio Galindo Kiuchi3, Jiazhi Wang4, Ruotian Li5, Zhiyu Ling6, Tingquan Zhou7, Zhenglong Wang8, Martin Martinek9, Helmut Pürerfellner9, Shaowen Liu10, Mitchell W Krucoff11. 1. Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China2Allgemein öffentliches Krankenhaus Elisabethinen Linz and Department of Cardiology, Elisabethinen University Teaching Hospital of Medical University Innsbruck and Vienna, Linz, Oberösterreich, Austria. 2. Department of Pediatrics, Children's Hospital of Fudan University, Shanghai, China. 3. Hospital e Clínica São Gonçalo, Department of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil. 4. Humanmedzin, Universität Leipzig, Leipzig University, Freistaat Sachsen, Germany. 5. Herzzentrum Universität Leipzig, Heart Center Leipzig University, Leipzig, Freistaat Sachsen, Germany. 6. Department of Cardiology, Second Affiliated Hospital Chongqing Medical University, Chongqing, China. 7. Department of Cardiology, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 8. Department of Cardiology, Affiliated Hospital of Zunyi Medical College, Zunyi, China. 9. Allgemein öffentliches Krankenhaus Elisabethinen Linz and Department of Cardiology, Elisabethinen University Teaching Hospital of Medical University Innsbruck and Vienna, Linz, Oberösterreich, Austria. 10. Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 11. Department of Medicine and Cardiology, Duke University Medical Center, Durham, North Carolina11Duke Clinical Research Institute, Durham, North Carolina.
Abstract
Importance: The timing and selection of patients with Kawasaki disease for corticosteroid use to prevent coronary artery complications remain controversial. Objective: To evaluate the effect of corticosteroid therapy in KD. Data Sources: Databases of Medline, The Cochrane Library, and the Clinicaltrials.gov website until July 2015. We used the key words ["Kawasaki disease"] and ["steroid" OR "corticosteroid"] to retrieve potentially relevant studies in the databases of Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2015. Both English and non-English literature was identified. Titles and abstracts were reviewed by 2 authors (S.C. and Y.D.) to determine suitability for inclusion. Relevant articles were reassessed by reviewing the full text. Discrepancies in study inclusion were resolved by consensus (M.G.K.). Study Selection: Clinical studies that compared corticosteroids plus intravenous immunoglobulin (IVIG) therapy with IVIG therapy alone in treating patients with KD. Studies either using corticosteroids as initial therapy or as rescue therapy were included. Data Extraction and Synthesis: Investigators independently extracted the data information. Data were quantitatively synthesized using random-effects analysis. Main Outcomes and Measures: Rate of coronary artery abnormalities. Results: Sixteen comparative studies characterizing 2746 patients were analyzed. The duration of illness before corticosteroids therapy was significantly shorter in the initial corticosteroids subset than in the rescue corticosteroids subset. The rate of coronary artery abnormalities was significantly lower in adjunctive corticosteroids therapy than in IVIG therapy (odds ratio [OR], 0.424; 95% CI, 0.270-0.665). Meta-regression based on known variables demonstrated that the overall efficacy was negatively correlated with the duration of illness before corticosteroid therapy (P < .001). Subgroup analysis, including studies using corticosteroids plus IVIG as initial therapy, showed a more advantageous effect than IVIG alone regarding coronary artery abnormality prevention (OR, 0.320; 95% CI, 0.183-0.560), whereas this benefit was not found in a subgroup of studies using corticosteroids as rescue therapy. Further analysis found that patients predicted at baseline to be at high risk of IVIG resistance seemed to obtain the greatest benefit from adjunctive corticosteroid therapy regarding coronary artery abnormality prevention (OR, 0.240; 95% CI, 0.123-0.467). The fever duration was significantly reduced in the corticosteroids group. The favorable effects of corticosteroids were conferred without an increased risk of adverse events. Conclusions and Relevance: This study highlights the importance of timing to prevent coronary artery complication in treating KD. High-risk patients with KD benefit greatly from a timely and potent adjunctive corticosteroid therapy strategy.
Importance: The timing and selection of patients with Kawasaki disease for corticosteroid use to prevent coronary artery complications remain controversial. Objective: To evaluate the effect of corticosteroid therapy in KD. Data Sources: Databases of Medline, The Cochrane Library, and the Clinicaltrials.gov website until July 2015. We used the key words ["Kawasaki disease"] and ["steroid" OR "corticosteroid"] to retrieve potentially relevant studies in the databases of Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2015. Both English and non-English literature was identified. Titles and abstracts were reviewed by 2 authors (S.C. and Y.D.) to determine suitability for inclusion. Relevant articles were reassessed by reviewing the full text. Discrepancies in study inclusion were resolved by consensus (M.G.K.). Study Selection: Clinical studies that compared corticosteroids plus intravenous immunoglobulin (IVIG) therapy with IVIG therapy alone in treating patients with KD. Studies either using corticosteroids as initial therapy or as rescue therapy were included. Data Extraction and Synthesis: Investigators independently extracted the data information. Data were quantitatively synthesized using random-effects analysis. Main Outcomes and Measures: Rate of coronary artery abnormalities. Results: Sixteen comparative studies characterizing 2746 patients were analyzed. The duration of illness before corticosteroids therapy was significantly shorter in the initial corticosteroids subset than in the rescue corticosteroids subset. The rate of coronary artery abnormalities was significantly lower in adjunctive corticosteroids therapy than in IVIG therapy (odds ratio [OR], 0.424; 95% CI, 0.270-0.665). Meta-regression based on known variables demonstrated that the overall efficacy was negatively correlated with the duration of illness before corticosteroid therapy (P < .001). Subgroup analysis, including studies using corticosteroids plus IVIG as initial therapy, showed a more advantageous effect than IVIG alone regarding coronary artery abnormality prevention (OR, 0.320; 95% CI, 0.183-0.560), whereas this benefit was not found in a subgroup of studies using corticosteroids as rescue therapy. Further analysis found that patients predicted at baseline to be at high risk of IVIG resistance seemed to obtain the greatest benefit from adjunctive corticosteroid therapy regarding coronary artery abnormality prevention (OR, 0.240; 95% CI, 0.123-0.467). The fever duration was significantly reduced in the corticosteroids group. The favorable effects of corticosteroids were conferred without an increased risk of adverse events. Conclusions and Relevance: This study highlights the importance of timing to prevent coronary artery complication in treating KD. High-risk patients with KD benefit greatly from a timely and potent adjunctive corticosteroid therapy strategy.
Authors: S M Dietz; D van Stijn; D Burgner; M Levin; I M Kuipers; B A Hutten; T W Kuijpers Journal: Eur J Pediatr Date: 2017-06-27 Impact factor: 3.183
Authors: Hany Simon Junior; Tania Miyuki Shimoda Sakano; Regina Maria Rodrigues; Adriana Pasmanik Eisencraft; Vitor Emanoel Lemos de Carvalho; Claudio Schvartsman; Amelia Gorete Afonso da Costa Reis Journal: J Pediatr (Rio J) Date: 2020-09-11 Impact factor: 2.990