Efficacy and Safety of Adjunctive Corticosteroids in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis of Randomized Trials
14 affiliations
- 1Department of Paediatrics and Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
- 2Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- 3Jeddah University, Jeddah, Saudi Arabia
- 4College of Medicine, Jazan University, Jazan, Saudi Arabia
- 5Ministry of Health, Abha, Aseer, Saudi Arabia
- 6Saudi German Hospital Aseer, Khamis Mushait, Saudi Arabia
- 7Alrayan Colleges, Medina, Saudi Arabia
- 8Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
- 9Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- 10Unaffiliated, Jeddah, Saudi Arabia
- 11Farwaniya Hospital, Ministry of Health, Kuwait City, Kuwait
- 12Ministry of Health, Riyadh, Saudi Arabia
- 13College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- 14Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt
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.
Methods: 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).
Results: 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.
Conclusions: 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.
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BibTeX
@article{ali2026efficacy,
title = {{Efficacy and Safety of Adjunctive Corticosteroids in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis of Randomized Trials}},
author = {Niemat Mohammed Tahir Ali and Ahmad Ayed AlShammari and Rana Alshehri and Renas Muneef Ageeli and Mohammed Hasen Mohammed Alghamdi and Khadijah Jadah Mohammed Asiri and Refad Talal AlKaki and Narmen Hamadelnil Ibrahim Eltrafi and Norah Ali Alwarthan and Wejdan Abdullah Omar Bamusa and Nourah AlNamash and Fahad Juwayid H. Alqahtani and Lara Sadik and Ahmed Sobhy},
journal = {Cardiology research},
year = {2026},
month = oct,
doi = {10.14740/cr2300},
url = {https://europepmc.org/article/PMC/PMC13719651},
note = {CC BY},
}
RIS
TY - JOUR
TI - Efficacy and Safety of Adjunctive Corticosteroids in Children With Kawasaki Disease: A Systematic Review and Meta-Analysis of Randomized Trials
AU - Niemat Mohammed Tahir Ali
AU - Ahmad Ayed AlShammari
AU - Rana Alshehri
AU - Renas Muneef Ageeli
AU - Mohammed Hasen Mohammed Alghamdi
AU - Khadijah Jadah Mohammed Asiri
AU - Refad Talal AlKaki
AU - Narmen Hamadelnil Ibrahim Eltrafi
AU - Norah Ali Alwarthan
AU - Wejdan Abdullah Omar Bamusa
AU - Nourah AlNamash
AU - Fahad Juwayid H. Alqahtani
AU - Lara Sadik
AU - Ahmed Sobhy
PY - 2026
DA - 2026/10/24
JO - Cardiology research
DO - 10.14740/cr2300
UR - https://europepmc.org/article/PMC/PMC13719651
AB - 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. Methods: 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). Results: 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. Conclusions: 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.
SN - 1923-2829
SN - 1923-2837
ER -