Review: corticosteroids with intravenous immunoglobulin reduced the incidence of coronary artery aneurysm formation in patients with Kawasaki disease

Question: In children with Kawasaki disease, does the use of additional corticosteroid with intravenous immunoglobulin (IVIG) improve cardiac outcomes? Review scope : Meta-analysis of all studies comparing outcomes in terms of coronary outcome incidence between children receiving IVIG and aspirin and additional steroid. The primary outcome was the presence of echocardiographic coronary artery aneurysm (CAA). Review methods : Medline, Cochrane Library, Embase and Clinical Trial Register searched up to March 2012. Quality assessment addressed diagnostic certainty, randomisation, blinding of outcome assessment and follow-up duration. Allocation concealment, attrition and selective reporting were not addressed. Fixed effects meta-analysis used for consistent outcome variables and random effects for inconsistent variables. Heterogeneity assessed by Cochran Q test and I2. Sensitivity analysis performed using: blinding; randomisation, steroid type; follow-up >4 weeks; high risk of IVIG resistance. Results : Nine studies identified including 1011 children. Six … Correspondence to Dr Bob Phillips, Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK; bob.phillips{at}doctors.org.uk