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

Chen, Shaojie; Dong, Ying; Yin, Yuehui; Krucoff, Mitchell W.

doi:10.1136/heartjnl-2012-302126

Cited by 128 publications

(85 citation statements)

References 42 publications

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“…A recent metaanalysis that included these trials, using different regimens of steroids and different prediction scores, found that a combination of corticosteroid with standard-dose IVIG as an initial treatment in high-risk patients reduced the rate of coronary artery abnormalities. 191 Thus, the addition of corticosteroid therapy to IVIG and ASA in the primary therapy of KD lowers the prevalence of coronary artery abnormalities, duration of fever, and inflammation among Japanese children at highest risk for IVIG resistance. However, the Japanese scoring systems for IVIG resistance and aneurysms have low sensitivity in North American populations.…”

Section: Corticosteroidsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,870

4,124

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BACKGROUND:Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS:To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and longterm outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS:These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances. K awasaki disease (KD) is an acute, self-limited febrile illness of unknown cause that predominantly affects children <5 years of age. When initially described, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute luminal dimensions from 25% to ≈4%. Ongoing studies with additional therapies have not substantially reduced this residual risk. The long-term prognosis is determined by the initial and current level of coronary artery involvement. Certain subsets of patients are at risk for myocardial ischemia from coronary artery thrombosis and stenoses. Medical management of such patients hinges on judicious use of thromboprophylaxis and vigilance to identify evolving stenoses. Invasive revascul...

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Section: Corticosteroidsmentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

McCrindle¹,

Rowley²,

Newburger³

et al. 2017

Circulation

2,870

4,124

View full text Add to dashboard Cite

show abstract

“…[14][15][16][17][18][19] A meta-analysis of these studies concluded that the addition of corticosteroids to intravenous immunoglobulin resulted in fewer coronary artery abnormalities than with treatment with intravenous immunoglobulin alone (OR 0·3, 95% CI 0·18-0·5). 20 However, heterogeneity in patient selection and treatment protocols severely limits application to our patient population. Three studies assessed 3-5 days of intravenous methylprednisolone (2 mg/kg per day) followed by a 2-4 week oral taper, 14,16,19 whereas the remaining three studies used a single pulse of intravenous methylprednisolone (30 mg/kg per day).…”

Section: Discussionmentioning

confidence: 99%

Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial

et al. 2014

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SummaryBackground Kawasaki disease, the most common cause of acquired heart disease in developed countries, is a self-limited vasculitis that is treated with high doses of intravenous immunoglobulin. Resistance to intravenous immunoglobulin in Kawasaki disease increases the risk of coronary artery aneurysms. We assessed whether the addition of infl iximab to standard therapy (intravenous immunoglobulin and aspirin) in acute Kawasaki disease reduces the rate of treatment resistance.

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“…Although the results of clinical trials evaluating the use of corticosteroids plus IVIG are confusing, Chen et al found that significantly fewer patients receiving IVIG plus corticosteroids developed coronary artery aneurysm than those receiving IVIG alone. 13 Our patient underwent the treatment with corticosteroid because he was resistant to 2 doses of IVIG. No coronary artery aneurysm was detected at the end of treatment.…”

Section: Discussionmentioning

confidence: 99%

A Case of IVIG-Resistant Kawasaki Disease with Gallbladder Hydrops

Yıldırım¹,

Binnetoğlu²,

Tekin³

et al. 2015

Turkiye Klinikleri J Pediatr

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

Abstract: Combination of corticosteroid with the conventional regimen of IVIG as an initial treatment strategy could reduce the risk of coronary abnormality.

Cited by 128 publications

References 42 publications

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial

A Case of IVIG-Resistant Kawasaki Disease with Gallbladder Hydrops

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