What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis

被引:22
作者
Jia, Xinyi [1 ,2 ,3 ]
Du, Xiao [1 ]
Bie, Shuxian [1 ]
Li, Xiaobing [2 ,3 ]
Bao, Yunguang [2 ,3 ]
Jiang, Mizu [1 ]
机构
[1] Zhejiang Univ, Childrens Hosp, Natl Clin Res Ctr Child Hlth, Dept Gastroenterol,Sch Med, Hangzhou 310003, Zhejiang, Peoples R China
[2] Zhejiang Univ, Dept Pediat, Jinhua Hosp, Jinhua, Zhejiang, Peoples R China
[3] Jinhua Municipal Cent Hosp, Jinhua, Zhejiang, Peoples R China
关键词
Kawasaki disease; aspirin; coronary artery abnormalities; meta-analysis; LONG-TERM MANAGEMENT; GAMMA-GLOBULIN; INTRAVENOUS IMMUNOGLOBULIN; HEALTH-PROFESSIONALS; DIAGNOSIS; SALICYLATE; STATEMENT; SAFETY;
D O I
10.1093/rheumatology/keaa050
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. The use of IVIG plus high- or low-dose aspirin for the initial treatment of Kawasaki disease remains controversial. The aim of this study was to evaluate the efficacy of IVIG plus high-dose aspirin compared with IVIG plus low-dose aspirin in the treatment of Kawasaki disease. Methods. Studies related to aspirin therapy for Kawasaki disease were selected by searching the databases of Medline (PubMed), Embase and the Cochrane Library before March 2019. Statistical analyses were performed by using a Review Manager Software package and STATA v.15.1. Results. Eight retrospective cohort studies, characterizing 12 176 patients, were analysed. Overall, no significant difference was found in the incidence of coronary artery abnormalities between the high- and low-dose aspirin groups [relative risk (RR) 1.15; 95% CI: 0.93, 1.43; P = 0.19; random-effects model]. The patients treated with high-dose aspirin had slightly faster resolution of fever [mean difference (MD) -0.30; 95% CI: -0.58, -0.02; P = 0.04; random-effects model]. but the rates of IVIG resistance (RR, 1.26; 95% CI: 0.55, 2.92; P = 0.59; random-effects model) and days in hospital (MD, 0.22; 95% CI: -0.93, 1.37; P = 0.71; random-effects model) were similar between the two groups. Conclusion. Low-dose aspirin plus IVIG might be as effective as high-dose aspirin plus IVIG for the initial treatment of Kawasaki disease. Considering that high-dose aspirin may cause more adverse reactions than low-dose aspirin, low-dose aspirin plus IVIG should be recommended as the first-line therapy in the initial treatment of Kawasaki disease.
引用
收藏
页码:1826 / 1833
页数:8
相关论文
共 31 条
[1]  
Amarilyo G, 2017, CLIN EXP RHEUMATOL, V35, pS209
[2]   Salicylate for the treatment of Kawasaki disease in children [J].
Baumer, J. H. ;
Love, S. J. L. ;
Gupta, A. ;
Haines, L. C. ;
Maconochie, I ;
Dua, J. S. .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2006, (04)
[3]   The nuts and bolts of PROSPERO: An international prospective register of systematic reviews [J].
Alison Booth ;
Mike Clarke ;
Gordon Dooley ;
Davina Ghersi ;
David Moher ;
Mark Petticrew ;
Lesley Stewart .
Systematic Reviews, 1 (1)
[4]   Hospitalizations for Kawasaki disease among children in the United States, 1988-1997 [J].
Chang, RKR .
PEDIATRICS, 2002, 109 (06) :e87
[5]   Appraising the Quality of Medical Education Research Methods: The Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education [J].
Cook, David A. ;
Reed, Darcy A. .
ACADEMIC MEDICINE, 2015, 90 (08) :1067-1076
[6]   Aspirin Dose and Prevention of Coronary Abnormalities in Kawasaki Disease [J].
Dallaire, Frederic ;
Fortier-Morissette, Zoe ;
Blais, Samuel ;
Dhanrajani, Anita ;
Basodan, Dania ;
Renaud, Claudia ;
Mathew, Mathew ;
De Souza, Astrid M. ;
Dionne, Audrey ;
Blanchard, Joel ;
Saulnier, Harrison ;
Kaspy, Kimberley ;
Rached-d'Astous, Soha ;
Dandah, Nagib ;
McCrindle, Brian W. ;
Human, Derek G. ;
Scuccimarri, Rosie .
PEDIATRICS, 2017, 139 (06)
[7]   European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative [J].
de Graeff, Nienke ;
Groot, Noortje ;
Ozen, Seza ;
Eleftheriou, Despina ;
Avcin, Tadej ;
Bader-Meunier, Brigitte ;
Dolezalova, Pavla ;
Feldman, Brian M. ;
Kone-Paut, Isabelle ;
Lahdenne, Pekka ;
McCann, Liza ;
Pilkington, Clarissa ;
Ravelli, Angelo ;
van Royen-Kerkhof, Annet ;
Uziel, Yosef ;
Vastert, Bas ;
Wulffraat, Nico ;
Kamphuis, Sylvia ;
Brogan, Paul ;
Beresford, Michael W. .
RHEUMATOLOGY, 2019, 58 (04) :672-682
[8]   Aspirin Dose in Kawasaki Disease: The Ongoing Battle [J].
Dhanrajani, Anita ;
Chan, Mercedes ;
Pau, Stephanie ;
Ellsworth, Janet ;
Petty, Ross ;
Guzman, Jaime .
ARTHRITIS CARE & RESEARCH, 2018, 70 (10) :1536-1540
[9]  
DURONGPISITKUL K, 1995, PEDIATRICS, V96, P1057
[10]   The Clinical Utility and Safety of a New Strategy for the Treatment of Refractory Kawasaki Disease [J].
Ebato, Takasuke ;
Ogata, Shohei ;
Ogihara, Yoshihito ;
Fujimoto, Mayu ;
Kitagawa, Atsushi ;
Takanashi, Manabu ;
Ishii, Masahiro .
JOURNAL OF PEDIATRICS, 2017, 191 :140-144