Use of corticosteroids during acute phase of Kawasaki disease

Table 1 Re-treatment with corticosteroids or additional intravenous immunoglobulin in Kawasaki disease patients unresponsive to initial intravenous immunoglobulin

Ref.	No. of patientswith KD	Definition ofunresponsiveness:BT, obs period, other	No. of patientsunresponsive to initial IVIG	Stageof CS Tx	Regimen	No. of patients re-Tx	Tx day after fever onset1	No. of patientswith response	No. of patientswith CAA	No. of patients with adverse effects
[22]	411	36 h after IVIG	63	2nd line	IVMP 30 mg/kg per day, 3 d	44	7 (6-8)	34	5	Hypertension 5, hypothermia 3, bradycardia 3, transient paralysis 1
					Followed Pd
					IVIG 1-2 g/kg	19	8 (5-11)	12	2
[40]	NA	≥ 37.5 °C, 48 h after IVIG	22	2nd line	IVMP 30 mg/kg per day, 3 d	11	NA	NA	2	Hypertension 10, hypothermia 1, bradycardia 9, hyperglycemia 6, aPTT↓ 3
					IVIG 2 g/kg	11	NA	NA	3
[23]	164	≥ 37.5 °C, 36-48 h after IVIG	27	2nd line	IVMP 30 mg/kg per day, 3 d	13	7 ± 1.3	NA	0	Bradycardia 2
		CRP↓ ≤ 50%
					IVIG 2 g/kg	14	8 ± 2.4	NA	3
[24]	237	≥ 38 °C, 36 h after IVIG	41	2nd line	IVMP 30 mg/kg per day, 3 d	14	7 (7-9)	7	5	Gastrointestinal bleeding 1
		37.5 °C-38 °C and CRP↓ ≤ 50%			Followed Pd
					IVIG 2 g/kg	27	8 (5-14)	21	7
[25]	262	≥ 37.5 °C, 48 h after IVIG	35	3rd line	IVMP 20 mg/kg per day, 3 d	9	NA	NA	7	NA
		CRP↓ ≤ 50%
					IVIG 1 g/kg	8	NA	NA	5
[26]	412	48 h after IVIG	74	3rd line	IVMP 30 mg/kg per day, 3 d	21	8 (IQR 8-9)	21	2	Hypertension 17, hypothermia 3, bradycardia 17, hyperglycemia 7, serum Na↓ 4
					Followed Pd

¹Median (range), median (IQR), or mean ± SD. IVIG: Intravenous immunoglobulin; KD: Kawasaki disease; BT: Body temperature; obs: Observation; Tx: Treatment; CS: Corticosteroids; CAA: Coronary artery aneurysm; NA: Not available; IVMP: Intravenous methylprednisolone pulse; Pd: Oral prednisolone; IQR: Interquartile range.