Intravenous Methylprednisolone Pulse Therapy Versus Intravenous Immunoglobulin (IVIG) In The Prevention Of Coronary Artery Disease In Children With Kawasaki Disease: A Randomized Controlled Trial

Abstract

BackgroundKawasaki disease (KD) is often complicated by coronary artery damage, including dilatation or aneurysms. IVIG is used with aspirin to prevent coronary artery abnormalities in KD. Since the primary treatment for other vasculitis is the use of corticosteroids, this study has been performed to evaluate the effect of intravenous pulse methylprednisolone therapy in preventing coronary artery lesions in KD.MethodA randomized, single-blind clinical trial was conducted on 40 KD patients aged 6 months to 5 years. Patients were randomized into two groups according to the main treatment plan in addition to aspirin: case group (intravenous methylprednisolone pulse for three consecutive days and then oral prednisolone for 5 days) and control group (intravenous immunoglobulin 2 gram/kg). Echocardiography was performed for all children at least 3 times, during the acute phase, two weeks, and two months later.ResultsData analysis at the end of the study was done on 40 patients (20 patients in each group). There were no significant differences in age and sex distribution, mean fever, and acute phase duration, as well as baseline echocardiography in 2 groups. The frequency of coronary artery lesion was 20% in the case group and 45% in the control group, after two weeks (p<0.05), but there was no significant difference between 2 groups in types of coronary artery lesion after two weeks and the frequency and severity of coronary artery lesion after two months.ConclusionIntravenous methylprednisolone pulse as initial line therapy effectively control systemic and vascular inflammation and decrease coronary artery damage in KD.