{ "abstract": "Background: Kawasaki disease is an acute pediatric vasculitis and a major cause of acquired heart disease in children. Although intravenous immunoglobulin (IVIG) with aspirin remains the standard treatment, some patients have persistent inflammation, IVIG resistance, or coronary complications. The role of adjunctive corticosteroids remains debated, particularly across different risk populations and corticosteroid regimens. This systematic review and meta-analysis evaluated the efficacy and safety of adjunctive corticosteroid therapy in children with Kawasaki disease.\n\nMethods: A systematic search of PubMed, Scopus, Cochrane CENTRAL, and Web of Science was conducted to identify randomized controlled trials comparing corticosteroid-containing treatment strategies with non-corticosteroid comparators, including standard IVIG-based initial treatment or additional IVIG in IVIG-resistant disease. The primary outcome was the change in C-reactive protein levels. Secondary outcomes included fever duration, IVIG resistance, laboratory markers, coronary outcomes, and adverse events. Pooled estimates were calculated using random-effects models and reported as mean differences (MD) or risk ratios with 95% confidence intervals (CIs).\n\nResults: Ten randomized controlled trials, including 5,796 unique children, were included. Adjunctive corticosteroid therapy was associated with a greater reduction in C-reactive protein levels compared with usual care alone (MD, −11.05; 95% CI, −18.27 to −3.84; P = 0.0027; I2 = 34.3%, P = 0.179). Corticosteroid therapy also reduced fever duration (MD, −1.03; 95% CI, −1.70 to −0.36; P = 0.0025; I2 = 85.2%, P < 0.001) and white blood cell count (MD, −1.07; 95% CI, −1.98 to −0.17; P = 0.020; I2 = 0.0%, P = 0.887). No significant differences were observed in IVIG resistance, coronary artery lesions, large/giant aneurysms, any adverse event, or adverse events leading to discontinuation.\n\nConclusions: Adjunctive corticosteroids were associated with improved inflammatory and early clinical response in Kawasaki disease, mainly through greater C-reactive protein reduction and shorter fever duration. However, corticosteroids did not significantly reduce overall coronary outcomes, and no statistically significant increase in the pooled adverse-event outcomes was detected. These findings support selective, risk-based use rather than routine universal administration.", "abstract_shown": true, "affiliations": [ "Department of Paediatrics and Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia", "Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia", "Jeddah University, Jeddah, Saudi Arabia", "College of Medicine, Jazan University, Jazan, Saudi Arabia", "Ministry of Health, Abha, Aseer, Saudi Arabia", "Saudi German Hospital Aseer, Khamis Mushait, Saudi Arabia", "Alrayan Colleges, Medina, Saudi Arabia", "Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates", "Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia", "Unaffiliated, Jeddah, Saudi Arabia", "Farwaniya Hospital, Ministry of Health, Kuwait City, Kuwait", "Ministry of Health, Riyadh, Saudi Arabia", "College of Medicine, Alfaisal University, Riyadh, Saudi Arabia", "Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt" ], "article_type": "research article", "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0 ], "name": "Niemat Mohammed Tahir Ali" }, { "affs": [ 1 ], "name": "Ahmad Ayed AlShammari" }, { "affs": [ 2 ], "name": "Rana Alshehri" }, { "affs": [ 3 ], "name": "Renas Muneef Ageeli" }, { "affs": [ 4 ], "name": "Mohammed Hasen Mohammed Alghamdi" }, { "affs": [ 5 ], "name": "Khadijah Jadah Mohammed Asiri" }, { "affs": [ 6 ], "name": "Refad Talal AlKaki" }, { "affs": [ 7 ], "name": "Narmen Hamadelnil Ibrahim Eltrafi" }, { "affs": [ 8 ], "name": "Norah Ali Alwarthan" }, { "affs": [ 9 ], "name": "Wejdan Abdullah Omar Bamusa" }, { "affs": [ 10 ], "name": "Nourah AlNamash" }, { "affs": [ 11 ], "name": "Fahad Juwayid H. Alqahtani" }, { "affs": [ 12 ], "name": "Lara Sadik" }, { "affs": [ 13 ], "name": "Ahmed Sobhy" } ], "bibtex": "https://research.draconitic.com/paper/fetbsnqa95s73.bib", "cited_by": 0, "doi": "10.14740/cr2300", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719651/?tool=EBI", "id": "fetbsnqa95s73", "issns": [ "1923-2829", "1923-2837" ], "landing_url": "https://europepmc.org/article/PMC/PMC13719651", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Article" ], [ "openalex", "2746|Kawasaki Disease and Coronary Complications" ] ], "openalex": "W7223441825", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719651/pdf/?tool=EBI", "pmcid": "PMC13719651", "pmid": "42964435", "published": "2026-10-24", "publisher": "Elmer Press", "ris": "https://research.draconitic.com/paper/fetbsnqa95s73.ris", "sources": [ { "first_seen": "2026-10-31T12:21:37Z", "native_id": "PMC:PMC13719651", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13719651" }, { "first_seen": "2026-11-02T12:23:34Z", "native_id": "PMC13719651", "source": "pmc", "url": "https://doi.org/10.14740/cr2300" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2746|Kawasaki Disease and Coronary Complications", "subfield": "surgery" } ], "title": "Efficacy and Safety of Adjunctive Corticosteroids in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis of Randomized Trials", "title_text": "Efficacy and Safety of Adjunctive Corticosteroids in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis of Randomized Trials", "type": "peer-reviewed", "updated_at": "2026-11-03T12:20:40Z", "url": "https://research.draconitic.com/paper/fetbsnqa95s73", "venue": "Cardiology research", "versions": [] }