Role of glucocorticoids in Kawasaki disease

Although treatment with intravenous immunoglobulin ( IVI g) with aspirin is the standard of care for children with Kawasaki disease ( KD ), 15–20% of patients fail to respond and experience persistent or recurrent fever after completion of IVI g administration. These IVI g non‐responders are at high risk for coronary artery lesions ( CAL ), and may need alternative or supplemental therapy. Based on retrospective studies (albeit with low evidence levels), glucocorticoid therapy was hitherto thought to worsen CAL . However, subsequent prospective studies have shown that prednisolone or IV methylprednisolone pulse as the initial or rescue therapy is effective in reducing CAL . A clinical trial known as the Randomized controlled trial to Assess Immunoglobulin plus Steroid Efficacy for KD ( RAISE ) Study, demonstrated the efficacy of prednisolone with initial IVI g, especially in predicted IVI g non‐responders. Several meta‐analyses have also supported the use of glucocorticoids for patients with severe forms of KD . Glucocorticoids can be considered as pre‐emptive therapy for children with severe KD and as rescue therapy for initial non‐responders. However, routine use of glucocorticoids in KD remains a contentious issue and would need further study.