SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1661380
Comparison of multiple doses of corticosteroids in Kawasaki disease: A Bayesian Network Analysis
Provisionally accepted
Xuan Li
Xuan TangDaoping Yang
Miao Hou
Qiu-Qin XuYunjia Tang
Bo Wang
Hongbiao Huang
Ye Chen
Zhiheng Liu
Guanghui Qian
Lv Haitao*- Children's Hospital of Soochow University, Suzhou, China
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Background: Kawasaki disease (KD) is a leading cause of acquired heart disease in children, with coronary artery lesion (CAL) as a major complication. Although intravenous immunoglobulin (IVIG) remains the cornerstone of therapy, corticosteroids continue to play an important role in the management of IVIG-resistant, high-risk, or severe Kawasaki disease. Nevertheless, the optimal dosing strategies and differential therapeutic effects of corticosteroids in children with distinct clinical subtypes of KD remain poorly understood, particularly in those at highest risk. Methods: We conducted a Bayesian network meta-analysis of five regimens: intravenous immunoglobulin alone (IVIG-alone), medium-dose methylprednisolone alone (MDMP-alone), high-dose methylprednisolone alone (HDMP-alone), IVIG-plus-low-dose methylprednisolone (IVIG-plus-LDP), and IVIG-plus-HDMP. Data from randomized controlled trials (RCTs) through December 2024 were included. Results: IVIG-plus-HDMP ranked highest for preventing treatment resistance and reducing fever in initial and refractory KD [Surface Under the Cumulative Ranking Curve (SUCRA) 0.79]. IVIG-plus-LDP had the highest probability of reducing coronary artery dilation (CAD) incidence (SUCRA 0.89). Corticosteroid-related side effects (e.g., bradycardia, hypertension) were mild, transient, and reversible across all regimens, with no severe adverse events reported. Conclusion: IVIG-plus-HDMP is the most effective therapy for acute symptom control in KD, particularly in high-risk or IVIG-resistant cases, while IVIG-plus-LDP appears superior for long-term prevention of coronary complications in the general KD population. Treatment selection should be individualized based on patient risk profile and treatment priorities, balancing rapid symptom management against long-term coronary outcomes.
Keywords: kawasaki disease, corticosteroid, Bayesian network analysis, Coronaryartery lesions, Immunoglobulin resistance
Received: 07 Jul 2025; Accepted: 26 Sep 2025.
Copyright: © 2025 Li, Tang, Yang, Hou, Xu, Tang, Wang, Huang, Chen, Liu, Qian and Haitao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lv Haitao, haitaosz@163.com
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