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Should we use steroids as primary therapy for Kawasaki disease?
  1. Laura Sevenoaks,
  2. Robert Tulloh
  1. Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
  1. Correspondence to Professor Robert Tulloh, Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK; robert.tulloh{at}bristol.ac.uk

https://doi.org/10.1136/archdischild-2020-319231

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    Clinical bottom lines

    • The use of additional steroids alongside current initial therapies may help to reduce the incidence of coronary artery abnormalities in high-risk patients (grade C). It is hoped that the forthcoming trial due to start this autumn will help answer these questions.

    • A scoring system for severity is available for the Japanese demographic to identify high-risk patients but has been shown to have insufficient evidence in the West (grade C)

    • A longer course with repeated doses of steroids appears to produce a more favourable outcome as opposed to pulsed or single-dose steroids (grade C).

    Question 1

    Should we use steroids as primary therapy for Kawasaki disease?

    Scenario

    A young boy has been brought along to his cardiology appointment to monitor his coronary artery aneurysm, which developed as a complication of Kawasaki disease when he was 11 months old. You wonder, if he would have been as likely to develop a coronary abnormality, if he had been treated with steroids when he first presented with Kawasaki disease.

    Structured clinical question

    In a child with acute severe Kawasaki disease, does the use of steroids as primary therapy, in addition to intravenous immunoglobulin, reduce the risk of developing a coronary abnormality?

    Search

    The MEDLINE library (1946–present), the Cochrane Library and the Embase database (1974–2018) were accessed. The search terms used were (Kawasaki OR mucocutaneous lymph node syndrome) AND (corticosteroid OR steroid OR Medical Subject Headings descriptor steroid) randomised controlled trials (RCTs), meta-analyses and systematic reviews were included to maintain a high quality of evidence. The references of the papers which were appropriate for abstract appraisal were also reviewed. Papers were excluded on the following basis: if the full text was not available and if the text was not in English or duplication. The papers were then excluded after the abstracts had been read and if they were not directly relevant to …

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    Footnotes

    • Funding This research was supported by National Institute for Health Research Bristol Cardiovascular Biomedical Research Centre.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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