Is IVIG plus corticosteroids better than IVIG alone for Kawasaki disease?

The answer may be "Yes," according to a recent study in Japan that compared treatment of Kawasaki disease (KD) with high-dose intravenous immunoglobulin (IVIG) and with IVIG plus a corticosteroid.

Investigators assigned 178 children in 12 hospitals who had KD to one of two treatment groups. One group received IVIG, 1 g/kg/day given over 12 hours, for two consecutive days. The other group received IVIG in the same manner plus prednisolone sodium succinate (IVIG + PSL) 2 mg/kg/day, three times daily IV.

When fever resolved in patients in the IVIG + PSL group, the IV steroid was discontinued but a full-dose oral steroid was continued until the C-reactive protein (CRP) level normalized. The steroid was then tapered over 15 days. Children in both groups received aspirin (30 mg/kg/day) and dipyridamole (2 mg/kg/day). The dosage of aspirin was decreased to 5 mg/kg/day after the CRP level normalized. Duration of steroid administration ranged from 18 to 100 days (median, 23 days). All patients were followed for at least two months.

Commentary Corticosteroids may indeed have a role in treatment of KD but, probably, not yet. The practice needs to be evaluated in the setting of treatment with single-dose IVIG and higher-dose aspirin, as typically used in the US. In an editorial that accompanies the article, Jane Burns, MD, suggests that investigators focus on identifying which children with KD don't respond to conventional therapy, then targeting corticosteroids or other therapies to this high-risk group.