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Aspirin and intravenous immunoglobulin (IVIG) are known to reduce the likelihood of coronary artery aneurysm in Kawasaki disease (KD); the efficacy of corticosteroids as part of initial therapy, on the other hand, is less clear. To address the issue, investigators conducted a meta-analysis of eight studies (five of which predate the use of IVIG in KD). The authors compared the rate of coronary artery aneurysm in 862 children with KD who were treated either with aspirin with or without IVIG or with those same therapies plus a corticosteroid.
Significantly fewer patients who received a corticosteroid in addition to standard therapy formed a coronary artery aneurysm than did those who received standard therapy alone. This finding remained after controlling for IVIG as a confounding variable. Coronary artery aneurysms were identified with two-dimensional echocardiography or coronary artery catheterization performed at least two weeks after therapy (Wooditch AC et al: Pediatrics 2005;116:989).
Commentary Using corticosteroids to treat KD is an important decision-one that I would not base on a meta-analysis alone. We should wait for the results of a large, prospective, multi-center trial of these drugs in KD before making them part of routine management.