دورية أكاديمية
Corticosteroids for the treatment of Kawasaki disease in children.
| العنوان: | Corticosteroids for the treatment of Kawasaki disease in children. |
|---|---|
| المؤلفون: | Green J; Children's & Adolescent Services, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK., Wardle AJ; Cardiology, Hammersmith Hospital, Imperial College London, London, UK., Tulloh RM; Congenital Heart Disease, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK. |
| المصدر: | The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2022 May 27; Vol. 5. Cochrane AN: CD011188. Date of Electronic Publication: 2022 May 27. |
| نوع المنشور: | Journal Article; Review; Systematic Review; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wiley Country of Publication: England NLM ID: 100909747 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-493X (Electronic) Linking ISSN: 13616137 NLM ISO Abbreviation: Cochrane Database Syst Rev Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2004- : Chichester, West Sussex, England : Wiley Original Publication: Oxford, U.K. ; Vista, CA : Update Software, |
| مواضيع طبية MeSH: | Coronary Artery Disease* , Mucocutaneous Lymph Node Syndrome*/drug therapy, Adrenal Cortex Hormones/adverse effects ; Child ; Fever/drug therapy ; Humans ; Immunoglobulins, Intravenous/adverse effects ; Length of Stay |
| مستخلص: | Background: Kawasaki disease (KD), or mucocutaneous syndrome, is the leading cause of childhood-acquired heart disease in high-income countries. There is much controversy on how best to treat children with KD and in particular who may benefit from additional treatment beyond the standard intravenous immunoglobulin (IVIG) and aspirin, such as the addition of corticosteroids. This is an update of the review first published in 2017. Objectives: To assess the impact of corticosteroid use on the incidence of coronary artery abnormalities in KD as either first-line or second-line treatment. Search Methods: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and two trials registers to 8 February 2021. We searched the reference lists of relevant articles for additional studies. Selection Criteria: We selected randomised controlled trials involving children with all severities of KD who were treated with corticosteroids, including different types of corticosteroids, different durations of treatment, and where corticosteroids were used alone or in conjunction with other accepted KD treatments. We included trials using corticosteroids for both first- and second-line treatment. Data Collection and Analysis: Two review authors independently selected studies, assessed study quality and extracted data using standard Cochrane methods. We performed fixed-effect model meta-analyses with odds ratios (ORs) or mean difference (MD) with 95% confidence intervals (CIs). We used a random-effects model when there was heterogeneity. We assessed the certainty of the evidence using GRADE. The outcomes of interest were incidence of coronary artery abnormalities, serious adverse events, mortality, duration of acute symptoms (such as fever), time for laboratory parameters to normalise, length of hospital stay and longer-term coronary morbidity. Main Results: This update identified one new study, therefore the analysis included eight trials consisting of 1877 participants. Seven trials investigated the use of corticosteroids in first-line treatment and one investigated second-line treatment. The trials were all of good methodological quality. On pooled analysis, corticosteroid treatment reduced the subsequent occurrence of coronary artery abnormalities (OR 0.32, 95% CI 0.14 to 0.75; 8 studies, 986 participants; moderate-certainty evidence), without resultant serious adverse events (0 events; 6 studies, 737 participants; moderate-certainty) and mortality (0 events; 8 studies, 1075 participants; moderate-certainty evidence). In addition, corticosteroids reduced the duration of fever (MD -1.34 days, 95% CI -2.24 to -0.45; 3 studies, 290 participants; low-certainty evidence), time for laboratory parameters (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) to normalise (MD -2.80 days, 95% CI -4.38 to -1.22; 1 study, 178 participants; moderate-certainty evidence), and length of hospital stay (MD -1.01 days, 95% CI -1.72 to -0.30; 2 studies, 119 participants; moderate-certainty evidence). None of the included studies reported long-term (greater than one year after disease onset) coronary morbidity. Authors' Conclusions: Moderate-certainty evidence shows that use of steroids in the acute phase of KD can be associated with reduced coronary artery abnormalities, reduced inflammatory markers and shorter duration of hospital stay when compared to no corticosteroids. There were no serious adverse events or deaths reported with or without corticosteroid use. Low-certainty evidence shows use of corticosteroids can reduce duration of clinical symptoms (fever and rash). None of the included studies reported on long-term (greater than one year after disease onset) coronary morbidity. Evidence presented in this systematic review agrees with current clinical guidelines on the use of corticosteroids in the first-line treatment in KD. (Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.) |
| التعليقات: | Update of: Cochrane Database Syst Rev. 2017 Jan 27;1:CD011188. (PMID: 28129459) |
| References: | Nihon Rinsho. 2008 Feb;66(2):332-7. (PMID: 18260333) Pediatrics. 1979 Feb;63(2):175-9. (PMID: 440805) J Am Coll Cardiol. 1996 Jul;28(1):253-7. (PMID: 8752822) N Engl J Med. 2007 Feb 15;356(7):663-75. (PMID: 17301297) J Pediatr. 2006 Sep;149(3):336-341. (PMID: 16939743) Circulation. 1996 Sep 15;94(6):1379-85. (PMID: 8822996) J Immunol Res. 2020 Nov 24;2020:4175821. (PMID: 33299898) Pediatr Int. 2012 Feb;54(1):99-103. (PMID: 22004042) Pediatr Int. 2017 Apr;59(4):397-403. (PMID: 27743415) J Pediatr. 2003 Jun;142(6):611-6. (PMID: 12838187) Heart. 2009 May;95(10):787-92. (PMID: 18697808) Pediatr Res. 2009 Nov;66(5):577-84. (PMID: 19680167) Heart. 2013 Jan;99(2):69-70. (PMID: 23086972) Pediatrics. 2003 Sep;112(3 Pt 1):495-501. (PMID: 12949272) Circulation. 2007 Jul 10;116(2):174-9. (PMID: 17576863) BMJ. 2002 Jun 15;324(7351):1424-5. (PMID: 12065266) Lancet. 2002 Oct 19;360(9341):1197-202. (PMID: 12401245) JAMA Pediatr. 2016 Dec 1;170(12):1156-1163. (PMID: 27749951) Eur J Pediatr. 2012 Mar;171(3):571-8. (PMID: 22057683) Arch Dis Child. 2015 Nov;100(11):1084-8. (PMID: 26111818) J Microbiol Immunol Infect. 2018 Jun;51(3):321-331. (PMID: 28927685) J Epidemiol. 2012;22(3):216-21. (PMID: 22447211) Arch Dis Child. 1991 Dec;66(12):1369-72. (PMID: 1776877) Pediatr Int. 2005 Apr;47(2):232-4. (PMID: 15771703) Arerugi. 1967 Mar;16(3):178-222. (PMID: 6062087) Cochrane Database Syst Rev. 2017 Jan 27;1:CD011188. (PMID: 28129459) J Pediatr. 1998 Aug;133(2):254-8. (PMID: 9709715) Inflammation. 2012 Jun;35(3):952-8. (PMID: 22012196) Curr Opin Cardiol. 2012 Nov;27(6):572-7. (PMID: 23075819) J Pediatr. 2011 May;158(5):831-835.e3. (PMID: 21168857) Arch Dis Child. 2014 Jan;99(1):74-83. (PMID: 24162006) Eur J Pediatr. 2004 Apr;163(4-5):229-33. (PMID: 14963702) Circulation. 2017 Apr 25;135(17):e927-e999. (PMID: 28356445) Pediatr Int. 2020 Oct;62(10):1135-1138. (PMID: 33001522) J Pediatr. 2003 Sep;143(3):363-7. (PMID: 14517521) J Pediatr. 1987 Nov;111(5):705-10. (PMID: 3668739) Pediatr Int. 2001 Jun;43(3):211-7. (PMID: 11380911) Lancet. 2012 Apr 28;379(9826):1613-20. (PMID: 22405251) Pediatrics. 2012 Jan;129(1):e17-23. (PMID: 22144699) Eur J Pediatr. 2008 Oct;167(10):1119-23. (PMID: 18175148) BMJ. 2004 Jun 19;328(7454):1490. (PMID: 15205295) Cochrane Database Syst Rev. 2003;(4):CD004000. (PMID: 14584002) Pediatr Cardiol. 2013 Oct;34(7):1756. (PMID: 23771701) Arch Dis Child. 2002 Apr;86(4):286-90. (PMID: 11919108) Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004175. (PMID: 17054199) |
| معلومات مُعتمدة: | United Kingdom CSO_ Chief Scientist Office |
| المشرفين على المادة: | 0 (Adrenal Cortex Hormones) 0 (Immunoglobulins, Intravenous) |
| تواريخ الأحداث: | Date Created: 20220527 Date Completed: 20220531 Latest Revision: 20240407 |
| رمز التحديث: | 20240407 |
| مُعرف محوري في PubMed: | PMC9139689 |
| DOI: | 10.1002/14651858.CD011188.pub3 |
| PMID: | 35622534 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1469-493X |
|---|---|
| DOI: | 10.1002/14651858.CD011188.pub3 |