Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

“…Unstable circulation and anticoagulant associated with plasma exchange might influence the rupture of the aneurysm. In addition, it has been reported that the use of corticosteroids in the acute phase of Kawasaki disease for patients with evolving coronary artery aneurysms might be associated with worsening involvement and impaired vascular remodeling [14]. Therefore, plasma exchange and the use of corticosteroids may have serious concerns in some situation.…”

Intravenous immunoglobulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis

“…Eight studies were excluded. Of these studies, one study compared a corticosteroid treatment group with a non-corticosteroid treatment group, 11 one study had equivocal treatment allocation process, 12 one study enrolled patients who were all treated with corticosteroid, and performed a before/after comparison, 13 five studies compared IVIG with corticosteroid alone therapy. [14][15][16][17][18] Consequently, nine clinical studies were enrolled in this meta-analysis.…”

“…8 9 Although corticosteroid is a useful treatment option for various forms of vasculitis, many physicians hesitate to use them because a report showed a high incidence of coronary artery abnormalities in patients who received a prolonged course of oral prednisolone. 10 Several clinical trials have been performed to investigate the efficacy of corticosteroid in Kawasaki disease [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] ; however, the role of a corticosteroid in the initial treatment of Kawasaki disease has not been established. In 2007, a multicentre, mixed ethnic group, prospective, blinded-endpoint, randomised, controlled trial reported that the efficacy of pulsed intravenous methyprednisolone added to conventional therapy did not improve coronary artery outcomes.…”

Clinical Manifestation, Diagnostics and Treatment of Kawasaki Disease: Known Data and Unsolved Questions

“…Применение ингибиторов ФНО ␣ представля-ется патогенетически обоснованным, поскольку повы-шение содержания ФНО ␣ может привести к локальной продукции эластолитических матриксных металлопро-теиназ в коронарных сосудах и образованию анев-ризм [52]. Уровень ФНО ␣ при СК повышен, особенно у больных с поражением коронарных артерий [53].…”

“…в 1979 г. В 2010 г. были опубликованы результаты проведенного Brian McCrindle и соавт. ретроспективного исследо-вания, показавшего, что диаметр аневризм КА через 2-3 мес и через 1 год после манифестации СК у паци-ентов, не получавших глюкокортикоиды, уменьшался, а у получавших эти препараты -увеличивался неза-висимо от продолжительности лечения [52]. Кроме того, известно, что применение глюкокортикоидов повышает риск тромбообразования, поэтому есть рекомендации о назначении этих препаратов больным СК одновре-менно с гепарином [55].…”