In spite of initial
intravenous immunoglobulin (
IVIG) treatment, a significant number of patients are unresponsive to it and are at a higher risk for coronary artery lesions.
Corticosteroids have been used as a secondary
drug or used in combination with
IVIG. Three options of using
corticosteroids for the treatment of patients during the acute phase of
Kawasaki disease, have been considered. The first is their use exclusively for patients unresponsive to
IVIG treatment. The second is their use in combination with
IVIG as the routine first line
therapy for all patients. The last is the use in the combination as the first line
therapy for selected patients at a high risk being unresponsive to initial
IVIG. However, it is uncertain that the
corticosteroids as the second line treatment are better than the additional
IVIG in patients unresponsive to initial
IVIG. The combination of
corticosteroids and
IVIG as the routine first line
therapy also have not enough evidences. The last option of using
corticosteroids - the combination of
corticosteroids and
IVIG in patients at high risk of unresponsiveness, is a properly reasonable treatment strategy. However, there have been no globally standardized predictive models for the unresponsiveness to initial
IVIG treatment. Therefore, future investigations to determine the best predictive model are necessary.