Adjunctive Prednisolone for Kawasaki Disease Save
An NEJM study has shown that glucocorticoids provide no added benefit when added to standard primary treatment in Kawasaki disease patients.
An open-label, randomized, controlled trial in China enrolled and randomized 3208 newly diagnosed Kawasaki children receive prednisolone plus standard treatment or standard treatment alone. The primary outcome was the occurrence of coronary-artery lesions at 1 month after illness onset.
Baseline coronary-artery lesions were seen in 870 of 3184 (27.3%) patients. At 1 month, coronary-artery lesions developed in 16% on prednisolone vs 13.8% not on prednisolone (adjusted risk difference, 1.1 percentage points; 95% confidence interval, −1.0 to 3.4; P=0.31). At 3 months, the incidence of coronary-artery lesions was 12.6% with prednisolone plus standard therapy and 10.5% with standard treatment alone; the percentage of participants with progression of coronary-artery lesions was 28.6% and 28.9%, respectively.
Nonsignificant differences in secondary outcomes included:
- Rescue therapy (4.6% vs 10.1%)
- Duration of fever (8.4 hours vs 13.2 hours)
- C-reactive protein reductions at 72 hours (67.5 mg/L vs 59.8 mg/L)
- Decreases in coronary-artery z scores
- Medium-to-giant coronary-artery aneurysms (1.9% vs 1.1%).
- Adverse events
Addition use of prednisolone in the treatment for Kawasaki disease does not appear to be justified.
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