Combination Therapy May Benefit Some With Kawasaki Disease

Adding corticosteroids to initial intravenous immunoglobulin seems beneficial for preventing coronary artery abnormalities in high-risk patients with Kawasaki disease (KD), according to a study published online Aug. 19 in the Journal of the American Heart Association.

Ryusuke Ae, MD, PhD, from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues compared standard intravenous immunoglobulin treatment and combination treatment with the addition of corticosteroids to initial standard treatment among patients with KD in Japan. Hospitals where ≥20 percent of patients received combination treatment were identified, and treatment (combination treatment) and control (standard intravenous immunoglobulin treatment) groups were identified. A total of 1,593 patients with KD in the treatment group and 1,593 controls were selected for each of 1,000 sample iterations, conducted to minimize sampling bias and potential confounders.

The researchers found that the median proportion of patients who developed coronary artery abnormalities was 4.6 and 8.8 percent among patients in the treatment group and controls, respectively (estimated risk ratio, 0.53). Treatment failure occurred in a median of 14.1 and 21.7 percent of patients in the treatment group and controls, respectively (estimated risk ratio, 0.65).

“It was surprising to see the dramatic results of our analysis. Clinicians should consider initial combination treatment with multiple-dose corticosteroids for high-risk Kawasaki disease patients,” Ae said in a statement.

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