The role of corticosteroids in the treatment of Kawasaki disease

Introduction: Kawasaki disease (KD) is a form of systemic vasculitis that can lead to complications of coronary artery lesions (CAL). Diagnosis without delay and treatment with intravenous immunoglobulin (IVIG) are vital for a better prognosis. Anti-inflammatory drugs are generally used empirically in pediatric patients as off label. Corticosteroids are effective with anti-inflammatory effects applied in vasculitis. Areas covered: The timing of corticosteroid treatment in KD has been widely discussed by scholars. Some corticosteroids may still be effective which could be useful for such specific populations as high-risk patients. In this narrative review, we searched clinical studies, meta-analyzes, and systemic reviews using the PubMed database to summarize the available evidence on corticosteroid usage in KD through October 2019 and then discussed the relevant issues. Expert opinion: Today, the available evidence is more powerful to recommend corticosteroids for KD, moving from an unproven therapy to an effective adjunctive treatment. We suggest using methylprednisolone pulse therapy as an alternative rescue therapy for immunoglobulin-resistant KD, as well as identifying high-risk patients who need initial corticosteroid with IVIG treatment with an adequate route, dose, and duration. In the future, studies that evaluate the precision role of corticosteroids for individualized KD patients with CAL are warranted.