Initial intravenous immunoglobulin therapy without aspirin for acute Kawasaki disease : a retrospective cohort study with a Bayesian inference
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVE: To clarify the necessity of acetylsalicylic acid (ASA) administration combined with intravenous immunoglobulin (IVIG) therapy in the treatment of acute Kawasaki disease.
DESIGN: Retrospective cohort study.
SETTING: Multicentre.
PARTICIPANTS: This study included 735 patients with Kawasaki disease aged ≤10 years and hospitalised between 4 and 10 days of illness in eight Japanese hospitals from January 2016 to December 2020.
EXPOSURES: High-dose (HD) ASA was administered with initial IVIG to 333 patients in 6 hospitals (HD group). ASA was not administered routinely to 402 patients in the other two hospitals, and low-dose ASA was only administered when patients developed coronary artery lesions or pericardial effusion (non-HD group).
PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the presence of coronary artery lesions, defined as a coronary artery diameter >+2.5 SD of body surface area within 1 month of onset. The secondary outcome was responsiveness to the initial IVIG therapy. Adjusted risk ratios for the outcomes were calculated using modified Poisson regression models. Bayesian analysis was conducted to estimate the posterior probability of the treatment effect of HD ASA under several prior distributions.
RESULTS: The incidence of coronary artery lesions was not significantly higher in the HD group than in the non-HD group (12/333 (3.6%) vs 15/402 (4.0%)). The proportion of non-responders to initial IVIG was similar between the two groups (HD group: 78/333 (23%); non-HD group: 83/402 (22%)). In the Bayesian analysis, considering a difference of ≤2% to be of no clinical importance, there was only a 9.3% chance of reduced risk of coronary artery lesions in the HD group compared with the non-HD group even with a strongly enthusiastic prior for HD treatment.
CONCLUSIONS: Compared with HD ASA treatment, treatment without ASA in the acute phase of Kawasaki disease was not associated with increased complications from Kawasaki disease.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
BMJ paediatrics open - 8(2024), 1 vom: 17. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hayashi, Ken [VerfasserIn] |
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| Links: |
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| Themen: |
Aspirin |
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| Anmerkungen: |
Date Completed 19.01.2024 Date Revised 04.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjpo-2023-002312 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM367235897 |
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| 245 | 1 | 0 | |a Initial intravenous immunoglobulin therapy without aspirin for acute Kawasaki disease |b a retrospective cohort study with a Bayesian inference |
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| 500 | |a Date Revised 04.03.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVE: To clarify the necessity of acetylsalicylic acid (ASA) administration combined with intravenous immunoglobulin (IVIG) therapy in the treatment of acute Kawasaki disease | ||
| 520 | |a DESIGN: Retrospective cohort study | ||
| 520 | |a SETTING: Multicentre | ||
| 520 | |a PARTICIPANTS: This study included 735 patients with Kawasaki disease aged ≤10 years and hospitalised between 4 and 10 days of illness in eight Japanese hospitals from January 2016 to December 2020 | ||
| 520 | |a EXPOSURES: High-dose (HD) ASA was administered with initial IVIG to 333 patients in 6 hospitals (HD group). ASA was not administered routinely to 402 patients in the other two hospitals, and low-dose ASA was only administered when patients developed coronary artery lesions or pericardial effusion (non-HD group) | ||
| 520 | |a PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the presence of coronary artery lesions, defined as a coronary artery diameter >+2.5 SD of body surface area within 1 month of onset. The secondary outcome was responsiveness to the initial IVIG therapy. Adjusted risk ratios for the outcomes were calculated using modified Poisson regression models. Bayesian analysis was conducted to estimate the posterior probability of the treatment effect of HD ASA under several prior distributions | ||
| 520 | |a RESULTS: The incidence of coronary artery lesions was not significantly higher in the HD group than in the non-HD group (12/333 (3.6%) vs 15/402 (4.0%)). The proportion of non-responders to initial IVIG was similar between the two groups (HD group: 78/333 (23%); non-HD group: 83/402 (22%)). In the Bayesian analysis, considering a difference of ≤2% to be of no clinical importance, there was only a 9.3% chance of reduced risk of coronary artery lesions in the HD group compared with the non-HD group even with a strongly enthusiastic prior for HD treatment | ||
| 520 | |a CONCLUSIONS: Compared with HD ASA treatment, treatment without ASA in the acute phase of Kawasaki disease was not associated with increased complications from Kawasaki disease | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a cardiology | |
| 650 | 7 | |a Aspirin |2 NLM | |
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| 650 | 7 | |a Immunoglobulins, Intravenous |2 NLM | |
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| 700 | 1 | |a Hoshino, Shinsuke |e verfasserin |4 aut | |
| 700 | 1 | |a Kobayashi, Naho |e verfasserin |4 aut | |
| 700 | 1 | |a Nakajima, Ryo |e verfasserin |4 aut | |
| 700 | 1 | |a Sagawa, Hironori |e verfasserin |4 aut | |
| 700 | 1 | |a Hayashiya, Toshikazu |e verfasserin |4 aut | |
| 700 | 1 | |a Suzuki, Atsushi |e verfasserin |4 aut | |
| 700 | 1 | |a Aota, Chie |e verfasserin |4 aut | |
| 700 | 1 | |a Nishijima, Setsuko |e verfasserin |4 aut | |
| 700 | 1 | |a Shimizu, Yasuyo |e verfasserin |4 aut | |
| 700 | 1 | |a Yamakawa, Masaru |e verfasserin |4 aut | |
| 700 | 1 | |a Tsuda, Etsuko |e verfasserin |4 aut | |
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