Updates in the Treatment of Kawasaki Disease

Purpose of Review: Kawasaki disease is the leading cause of childhood-onset acquired heart disease in developed countries, and if left untreated, leads to complications of coronary artery aneurysms (CAA) in approximately 25% of cases. While the gold standard treatment remains intravenous immunoglobulin (IVIG) and aspirin (ASA), there remains a lack of evidence for choosing optimal treatment for high-risk and refractory cases. This article summarizes the current recommendations for initial therapy and reviews the latest research and guidelines regarding anti-inflammatory treatment to minimize the incidence of coronary artery lesions. Recent Findings: Recent studies suggest that an antiplatelet dose of ASA, when administered with IVIG, is not inferior to higher ASA doses in reducing the risk of coronary artery abnormalities. Corticosteroids and infliximab are currently two agents that have been studied the most in patients deemed to be at higher risk or in those who fail to respond to IVIG. Also, only corticosteroids have proved effective in decreasing the incidence of CAA in a randomized trial in high-risk Japanese population. Summary: The ongoing challenge continues to be early identification of high-risk Kawasaki patients in all ethnic populations who would benefit from intensified primary therapy.