Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease/Children's
Hospital of Shaanxi Provincial People's Hospital; Beijing Children's Hospital, Capital Medical University; Shanghai
Children's Medical Center; Children's Hospital of Shanghai Jiao Tong University; Xianyang Children's Hospital of
Shaanxi Province; Suzhou Children's Hospital, Suzhou University; Children's Hospital of Chongqing Medical University;
Expert Committee of Advanced Training for Pediatrician, China Maternal and Children's Health Association; Editorial Board of
Chinese Journal of Contemporary Pediatrics
Abstract：Kawasaki disease (KD) is one of the common acquired heart diseases in under-5-year-old children and is an acute self-limiting vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for preventing coronary artery aneurysm in the acute stage of KD. However, glucocorticoid (GC), infliximab, and other immunosuppressants are options for the treatment of KD patients with a high risk of coronary artery aneurysm, no response to intravenous immunoglobulin and a confirmed diagnosis of coronary artery aneurysm. At present, there are still controversies over the use of GC in the treatment of KD. With reference to the latest research findings of KD treatment in China and overseas, this consensus invited domestic pediatric experts to fully discuss and put forward recommendations on the indications, dosage, and usage of GC in the first-line and second-line treatment of KD.
2 Du ZD. Epidemiologic features of Kawasaki disease in China[C]. Yokohama: 12th International Kawasaki Disease Symposium, 2018.
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association[J]. Circulation, 2017, 135(17): e927-e999. PMID: 28356445. DOI: 10.1161/CIR.0000000000000484.
Yang TJ, Lin MT, Lu CY, et al. The prevention of coronary arterial abnormalities in Kawasaki disease: a meta-analysis of the corticosteroid effectiveness[J]. J Microbiol Immunol Infect, 2018, 51(3): 321-331. PMID: 28927685. DOI: 10.1016/j.jmii.2017.08.012.
Kato H, Koike S, Yokoyama T. Kawasaki disease: effect of treatment on coronary artery involvement[J]. Pediatrics, 1979, 63(2): 175-179. PMID: 440805.
Wright DA, Newburger JW, Baker A, et al. Treatment of immune globulin-resistant Kawasaki disease with pulsed doses of corticosteroids[J]. J Pediatr, 1996, 128(1): 146-149. PMID: 8551407. DOI: 10.1016/s0022-3476(96)70447-x.
de Graeff N, Groot N, Ozen S, et al. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease: the SHARE initiative[J]. Rheumatology (Oxford), 2019, 58(4): 672-682. PMID: 30535127. DOI: 10.1093/rheumatology/key344.
Miyata K, Kaneko T, Morikawa Y, et al. Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (post RAISE): a multicentre, prospective cohort study[J]. Lancet Child Adolesc Health, 2018, 2(12): 855-862. PMID: 30337183. DOI: 10.1016/S2352-4642(18)30293-1.
Ae R, Abrams JY, Maddox RA, et al. Corticosteroids added to initial intravenous immunoglobulin treatment for the prevention of coronary artery abnormalities in high-risk patients with Kawasaki disease[J]. J Am Heart Assoc, 2020, 9(17): e015308. PMID: 32811256. PMCID: PMC7660775. DOI: 10.1161/JAHA.119.015308.
Kobayashi T, Saji T, Otani T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial[J]. Lancet, 2012, 379(9826): 1613-1620. PMID: 22405251. DOI: 10.1016/S0140-6736(11)61930-2.
Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 guideline on diagnosis and management of cardiovascular sequelae in Kawasaki disease[J]. Circ J, 2020, 84(8): 1348-1407. PMID: 32641591. DOI: 10.1253/circj.CJ-19-1094.
Patel RM, Shulman ST. Kawasaki disease: a comprehensive review of treatment options[J]. J Clin Pharm Ther, 2015, 40(6): 620-625. PMID: 26547265. DOI: 10.1111/jcpt.12334.
Ogata S, Ogihara Y, Honda T, et al. Corticosteroid pulse combination therapy for refractory Kawasaki disease: a randomized trial[J]. Pediatrics, 2012, 129(1): e17-e23. PMID: 22144699. DOI: 10.1542/peds.2011-0148.
Gamez-Gonzalez LB, Moribe-Quintero I, Cisneros-Castolo M, et al. Kawasaki disease shock syndrome: unique and severe subtype of Kawasaki disease[J]. Pediatr Int, 2018, 60(9): 781-790. PMID: 29888440. DOI: 10.1111/ped.13614.
Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association[J]. Circulation, 2004, 110(17): 2747-2771. PMID: 15505111. DOI: 10.1161/01.CIR.0000145143.19711.78.
akan M, Gemici H, Aktay-Ayaz N, et al. Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease[J]. Turk J Pediatr, 2016, 58(4): 415-418. PMID: 28276216. DOI: 10.24953/turkjped.2016.04.012.
Han SB, Lee SY. Macrophage activation syndrome in children with Kawasaki disease: diagnostic and therapeutic approaches[J]. World J Pediatr, 2020, 16(6): 566-574. PMID: 32418074. DOI: 10.1007/s12519-020-00360-6.
Caplan A, Fett N, Rosenbach M, et al. Prevention and management of glucocorticoid-induced side effects: a comprehensive review: gastrointestinal and endocrinologic side effects[J]. J Am Acad Dermatol, 2017, 76(1): 11-16. PMID: 27986133. DOI: 10.1016/j.jaad.2016.02.1239.
Ritter A, Burow A, Vallelian F, et al. Systemic glucocorticoids: diagnosis, prophylaxis and treatment of side effects[J]. Praxis (Bern 1994), 2014, 103(17): 987-998. PMID: 25146942. DOI: 10.1024/1661-8157/a001747.
53 Rahmati Y, Mollanoori H, Kakavandi N, et al. Gene expression analysis in Kawasaki disease; bioinformatics and experimental approach[J]. Inform Med Unlocked, 2020, 20: 100423. DOI: 10.1016/j.imu.2020.100423.
Chen SJ, Dong Y, Kiuchi MG, et al. Coronary artery complication in Kawasaki disease and the importance of early intervention: a systematic review and meta-analysis[J]. JAMA Pediatr, 2016, 170(12): 1156-1163. PMID: 27749951. DOI: 10.1001/jamapediatrics.2016.2055.
