Corticosteroids can benefit Kawasaki patients, new meta-analysis says

February 27, 2013 – Mitchell Krucoff, MD, and colleagues from China analyzed studies of corticosteroids used in concert with intravenous immunoglobulin therapy.

Adding corticosteroid to intravenous immune globulin (IVIG) therapy could reduce the risk of coronary abnormalities in patients with Kawasaki disease, according to a new meta-analysis.

The study, conducted by the DCRI’s Mitchell Krucoff, MD, along with researchers from China, was published in the January 15 issue of the journal Heart.

Kawasaki disease is a rare childhood condition in which the blood vessels become inflamed. The disease, which is poorly understood, is often accompanied by coronary artery abnormalities in 15 to 25 percent of untreated patients. Kawasaki disease is usually treated with a combination of aspirin and IVIG, a sterile solution of concentrated antibodies extracted from blood plasma of healthy donors. However, about 20 percent of patients have persistent or recurrent fever after IVIG, and these patients have a particularly high risk of developing coronary artery abnormalities.

Corticosteroids, artificial drugs that replicate the function of hormones produced naturally by the adrenal glands, have been shown to be useful in treating these kinds of coronary abnormalities in the general population. Corticosteroids’ effectiveness in the context of Kawasaki disease has been studied previously, yet researchers have been unable to reach any definitive conclusions. To better understand corticosteroids’ potential role in treating coronary abnormalities in Kawasaki patients, Krucoff and his colleagues conducted a meta-analysis of existing studies.

The researchers conducted a search of all studies entered into the Medline, Cochrane Library, Clinical Trials, and Embase databases through March 31, 2012. The initial search returned 1,753 items. After excluding irrelevant and incomplete studies, just nine studies remained. A close analysis of these nine studies showed that IVIG-plus-corticosteroid therapy significantly reduced the risk of coronary abnormality. Similar results were observed in subgroup analyses of randomized controlled studies, studies focused on patients with a high risk of IVIG resistance, and studies with blinded-endpoint manner. There was no significant difference in the incidences of severe adverse events between the IVIG-plus-corticosteroid group and the IVIG group.

Krucoff and his colleagues concluded that differences in study design, patient enrollment, drug administration, endpoint manner, and follow-up duration have previously prevented researchers from drawing definitive conclusions about the value of corticosteroids in Kawasaki patients. However, a closer examination of their findings demonstrates a clear benefit. Additional large-scale, randomized clinical trials should be conducted to better define the extent of that benefit, the researchers said.