Caution in Generalizing the Use of Adjunctive Primary Corticosteroids in Kawasaki Disease to Unselected Non-Japanese Populations

To the Editor In their updated systematic review and meta-analysis, Chen et al¹ analyzed data on the role of corticosteroids in treatment of Kawasaki disease (KD). They conclude that coronary artery abnormalities are significantly reduced in patients with KD receiving primary adjunctive corticosteroids compared with those receiving intravenous immunoglobulin (IVIG) alone. In addition, they conclude that timing of corticosteroids is important because coronary artery outcomes are better with primary corticosteroids than with rescue therapy following IVIG nonresponse. Despite the importance of defining the role of corticosteroids in KD, we urge caution in extrapolating these findings to the treatment of KD in unselected and non-Japanese patients.