Combination therapy reduces risk for abnormalities, treatment failure in Kawasaki disease
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Corticosteroids with standard treatment for patients with Kawasaki disease reduced the risk for coronary artery abnormalities and treatment failure, researchers found.
“Our study along with others support the conclusion that coronary artery complications can be reduced or prevented in many severe cases with early intensification of standard treatment such as use of a combination of intravenous immunoglobulin and corticosteroid,” Ryusuke Ae, MD, PhD, a guest researcher at the CDC when conducting this study and now an assistant professor in the department of public health at the Center for Community Medicine at Jichi Medical University in Shimotsuke, Japan, told Healio.
Kawasaki disease in Japanese patients
For the retrospective cohort study published in the Journal of the American Heart Association, researchers assessed survey data of patients from Japan with Kawasaki disease with high risk for nonresponse to standard treatment.
The survey compared the effectiveness of standard treatment, defined as 2 g/kg of IV immunoglobulin as a single infusion with aspirin, with combination treatment, defined as corticosteroids with standard treatment, to prevent coronary artery abnormalities. Survey data were collected in patients diagnosed from 2009 to 2010, during which the use of combination treatment was extremely rate, and from 2015 to 2016, a period when combination therapy was commonly used.
Researchers identified hospitals in which at least 20% of patients were treated with the combination approach and selected patients for treatment and control groups that were matched by sex, age, Kawasaki disease recurrence and illness day at initial treatment. To minimize potential confounders and sampling bias, the selection of matched groups and subsequent analyses were conducted 1,000 times.
Outcomes measured for this study were all coronary artery abnormalities and initial treatment failure.
From each of the 1,000 sample iterations, researchers assessed data from 1,593 patients in the treatment group with combination therapy and 1,593 controls treated with standard care. Both groups were treated at 115 hospitals.
Coronary artery abnormalities occurred in 4.6% of patients in the treatment group (95% CI, 3.8-5.8) and 8.8% of those in the control group (95% CI, 7.5-10). This equated to a median RR of 0.53 (95% CI, 0.41-0.67).
Treatment failure occurred in 14.1% of patients in the treatment group (95% CI, 12.4-15.9) compared with 21.7% of those in the control group (95% CI, 19.8-23.4), with an estimated RR of 0.65 (95% CI, 0.56-0.75).
Combination treatment in a clinical setting
“Clinicians should consider combination treatment with multiple-dose corticosteroids for high-risk Kawasaki disease patients,” Ae said in an interview. “Early diagnosis and prompt treatment are important for children with Kawasaki disease to prevent development of cardiac complications.”
Ae added that more research is needed regarding other treatment options for patients with Kawasaki disease. “Recent studies have indicated that infliximab may also be effective in combination with initial [IV immunoglobulin] treatment for treating Kawasaki disease,” Ae told Healio. “Further research is needed to compare this treatment regimen with combination multiple-dose corticosteroid treatment to determine which is more effective in preventing development of coronary artery abnormalities in high-risk patients with Kawasaki disease.”
For more information:
Ryusuke Ae, MD, PhD, can be reached at shirouae@jichi.ac.jp.
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