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World J Clin Pediatr. Nov 8, 2015; 4(4): 135-142
Published online Nov 8, 2015. doi: 10.5409/wjcp.v4.i4.135
Use of corticosteroids during acute phase of Kawasaki disease
Jeong Jin Yu
Jeong Jin Yu, Department of Pediatrics Cardiology, College of Medicine, Ulsan University, Ulsan 680-749, South Korea
Jeong Jin Yu, Department of Pediatrics, Asan Medical Center, Seoul 138-736, South Korea
Author contributions: Yu JJ solely contributed to this manuscript.
Conflict-of-interest statement: I have no relevant financial relationships to disclose or conflicts of interest to resolve.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeong Jin Yu, MD, PhD, Department of Pediatrics, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea. pediatrist@medimail.co.kr
Telephone: +82-2-30103924 Fax: +82-2-4733725
Received: July 2, 2015
Peer-review started: July 8, 2015
First decision: August 25, 2015
Revised: August 28, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 8, 2015
Processing time: 131 Days and 7.3 Hours
Abstract

In spite of initial intravenous immunoglobulin (IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. Three options of using corticosteroids for the treatment of patients during the acute phase of Kawasaki disease, have been considered. The first is their use exclusively for patients unresponsive to IVIG treatment. The second is their use in combination with IVIG as the routine first line therapy for all patients. The last is the use in the combination as the first line therapy for selected patients at a high risk being unresponsive to initial IVIG. However, it is uncertain that the corticosteroids as the second line treatment are better than the additional IVIG in patients unresponsive to initial IVIG. The combination of corticosteroids and IVIG as the routine first line therapy also have not enough evidences. The last option of using corticosteroids - the combination of corticosteroids and IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.

Keywords: Kawasaki disease; Methylprednisolone; Corticosteroids; Coronary aneurysm; Immunoglobulins; Prednisolone; Fever

Core tip: In spite of initial intravenous immunoglobulin (IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions. Corticosteroids have been used as a secondary drug or used in combination with IVIG. There are several options of using corticosteroids for the treatment of patients with Kawasaki disease during the acute phase. A thorough review of the use of corticosteroids in acute phase Kawasaki disease was performed in this paper.