Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis

Abstract

Background Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high-dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD. Methods Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25 th , 2019. Data were analyzed using STATA Version 15.1. Additionally, publication bias and sensitivity analysis were also performed by STATA version 15.1. Results Six studies were included in our analysis of the rate of coronary artery lesion (CAL), five reports for IVIG-resistant KD (rKD), and four for the duration of fever and hospitalization. However, no significant differences were found between low-dose and high-dose aspirin groups in the incidence of CAL (risk ratio (RR), 0.85; 95%CI (0.63, 1.14); P = 0.28), the risk of rKD (RR, 1.39; 95%CI (1.00, 1.93); P = 0.05), and duration of fever and hospitalization (the mean standard deviation (SMD), 0.03; 95%CI (-0.16, 0.22); P = 0.78). Conclusion Low-dose aspirin (3–5 mg·kg -1 ·d -1 ) may be as effective as the use of high-dose aspirin (≥30 mg·kg -1 ·d -1 ) for the initial treatment of KD. Further well-designed randomized clinical trials are needed to evaluate the efficacy of low-dose aspirin for the initial treatment of KD.

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

“…In 2012, Callinan reported a higher CAL incidence of 19% in California ( 21 ). Several studies have been conducted in order to reduce the occurrence of CAL, for example involving adjunctive corticosteroid therapy, different doses of aspirin, and tumor necrosis factor inhibitors in immunoglobulin-resistant KD ( 3 , 38 , 39 ). Unfortunately, they all failed to find convincing positive results.…”

Kawasaki disease for the paediatric dermatologist: skin manifestations and new insights into the pathophysiology

“…30 Ciclosporin targets this pathway. 34 The efficacy of aspirin remains controversial. A meta-analysis showed no difference in terms of morbidity between low doses (3-5 mg/kg/day) vs. higher doses (> 30 mg/kg/day) of aspirin given during the acute phase of the disease.…”

Kawasaki Disease: an Update

“…Moderate-dose (30–50 mg/kg/day) or high-dose (80 to 100 mg/kg/day) ASA is generally utilized until the patient is afebrile in the United States, Japan, and Western Europe. There does not appear to be a significant difference between low-dose (3-5 mg/kg/day) ASA versus high-dose ASA in regard to incidence of CALs, duration of fever, or duration of hospitalization [ 65 •]. There is also no clear evidence that any dose of ASA will decrease development of CALs [ 66 ].…”