Consensus Committee of experts on Kawasaki Disease and Chinese Journal of Contemporary Pediatrics – the expert consensuses on intravenous immunoglobulin, aspirin, and glucocorticoid
DOI:
https://doi.org/10.15584/ejcem.2024.1.8Keywords:
aspirin, children, glucocorticoid, intravenous immunoglobulin, Kawasaki diseaseAbstract
Introduction and aim. Kawasaki disease (KD) is an acute vasculitis with unknown etiology, usually occurring in chil dren under 5 years old. This article will summarize the three consensuses formulated in China about KD.
Material and methods. English databases for consensus search include UpToDate, BMJ Clinical Evidence, National Guideline Clearinghouse, Joanna Briggs Institute Library, Cochrane Library, and PubMed, etc.; Chinese databases in clude China Biomedical Literature Service, China Knowledge Network, Wanfang database, etc. All literature searches ended on February 28, 2022.
Analysis of the literature. KD is a common acquired heart disease in children and can lead to severe complications such as coronary injury. However, intravenous immunoglobulin (IVIG) combined with oral aspirin (Asp) is currently recognized as the most effective treatment in KD acute stage and the first-line treatment to prevent cardiovascular complications. Glucocorticoid (GC) is mainly used for KD patients with a high risk of coronary artery aneurysm (CAA), no immunoglobulin response, and confirmed CAA. There are already consensus guidelines on diagnosing and treat ing KD in different countries. This article summarizes the relevant expert consensus on aspirin, glucocorticoids and IVIG for the treatment of Kawasaki disease in China.
Conclusion. Still, there are inconsistent opinions in the literature on the mechanism, optimal timing, and dosage of medication for KD.
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References
Gorelik M, Chung SA, Ardalan K, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. J Arthritis Care Res (Hoboken). 2022;74(4):538-548. doi: 10.1002/acr.24838
Bayers S, Shulman ST, Paller AS. Kawasaki disease: part II. Complications and treatment. J Am Acad Dermatol. 2013;69(4):513.e1-8; 521-522. doi: 10.1016/j.jaad.2013.06.040
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. J Circulation. 2017;135(17):e927-e999. doi: 10.1161/CIR.0000000000000484
Kim GB, Park S, Eun LY, et al. Epidemiology and Clinical Features of Kawasaki Disease in South Korea, 2012-2014. J Pediatr Infect Dis. 2017;36(5):482-485. doi: 10.1097/INF.0000000000001474
Manlhiot C, O'Shea S, Bernknopf B, et al. Epidemiology of Kawasaki Disease in Canada 2004 to 2014: Comparison of Surveillance Using Administrative Data vs Periodic Medical Record Review. Can J Cardiol. 2018;34(3):303-309. doi: 10.1016/j.cjca.2017.12.009
Huang WC, Huang LM, Chang IS, et al. Epidemiologic features of Kawasaki disease in Taiwan, 2003-2006. J Pediatrics. 2009;123(3):e401-5. doi: 10.1542/peds.2008-2187
Kim GB, Han JW, Park YW, et al. Epidemiologic features of Kawasaki disease in South Korea: data from nationwide survey, 2009-2011. J Pediatr Infect Dis. 2014;33(1):24-27. doi: 10.1097/INF.0000000000000010
Makino N, Nakamura Y, Yashiro M, et al. Descriptive epidemiology of Kawasaki disease in Japan, 2011-2012: from the results of the 22nd nationwide survey. J Epidemiol. 2015;25(3):239-245. doi: 10.2188/jea.JE20140089
Du ZD, Zhao D, Du J, et al. Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004. J Pediatr Infect Dis. 2007;26(5):449-451. doi: 10.1097/01.inf.0000261196.79223.18
Ma XJ, Yu CY, Huang M, et al. Epidemiologic features of Kawasaki disease in Shanghai from 2003 through 2007. J Chin Med (Engl). 2010;123(19):2629-2634. doi:
Lin MC, Lai MS, Jan SL, Fu YC. Epidemiologic features of Kawasaki disease in acute stages in Taiwan, 1997-2010: effect of different case definitions in claims data analysis. J Chin Med Assoc. 2015;78(2):121-126. doi: 10.1016/j.jcma.2014.03.009
Abstracts of the 10th International Kawasaki Disease Symposium. February 7-10, 2012. Kyoto, Japan. J Pediatr Int. 2012;54(1):38-142. doi: 10.1111/j.1442-200X.2012.03534.x
He L, Liu F, Huang GY, et al. Application of selective coronary angiography in children with Kawasaki disease complicated with severe coronary artery lesion. J Zhonghua Er Ke Za Zhi. 2019;57(2):108-112. doi: 10.3760/cma.j.issn.0578-1310.2019.02.009
Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med. 1986;315(6):341-347. doi: 10.1056/NEJM198608073150601
Wu MH, Chen HC, Yeh SJ, et al. Prevalence and the long-term coronary risks of patients with Kawasaki disease in a general population <40 years: a national database study. J Circ Cardiovasc Qual Outcomes. 2012;5(4):566-570. doi: 10.1161/CIRCOUTCOMES.112.965194
Rife E, Gedalia A. Kawasaki Disease: an Update. J Curr Rheumatol Rep. 2020;22(10):75. doi: 10.1007/s11926-020-00941-4
Zhang RL, Lo HH, Lei C, et al. Current pharmacological intervention and development of targeting IVIG resistance in Kawasaki disease. J Curr Opin Pharmacol. 2020;54:72-81. doi: 10.1016/j.coph.2020.08.008
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease. J Zhongguo Dang Dai Er Ke Za Zhi. 2021;23(9):867-876. doi: 10.7499/j.issn.1008-8830.2107110
Shaanxi Province Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial People's Hospital; Children's Hospital of Shanghai Jiao Tong University; Beijing Children's Hospital of Capital Medical University. [Pediatric expert consensus on the application of aspirin in Kawasaki disease]. J Zhongguo Dang Dai Er Ke Za Zhi. 2022;24(6):597-603. doi: 10.7499/j.issn.1008-8830.2203190
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial People's Hospital; Beijing Children's Hospital, Capital Medical University; Shanghai Children's Medical Center; Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease. Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease. J Zhongguo Dang Dai Er Ke Za Zhi. 2022;24(3):225-231. doi: 10.7499/j.issn.1008-8830.2112033
Suzuki T, Michihata N, Aso S, et al. Sodium-containing versus sodium-trace preparations of IVIG for children with Kawasaki disease in the acute phase. Eur J Pediatr. 2021;180(11):3279-3286. doi: 10.1007/s00431-021-04096-x
Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. J Allergy. 2009;64(5):669-677. doi: 10.1111/j.1398-9995.2009.01973.x
Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. J Allergy. 2009;64(5):669-677. doi: 10.1111/j.1398-9995.2009.01973.x
Ozen S, Marks SD, Brogan P, et al. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis-the SHARE initiative. J Rheumatology (Oxford). 2019;58(9):1607-1616. doi: 10.1093/rheumatology/kez041
Imbach P, Barandun S, Baumgartner C, et al. High-dose intravenous gammaglobulin therapy of refractory, in particular idiopathic thrombocytopenia in childhood. J Helv Paediatr Acta. 1981;36(1):81-86. doi:
Kane J, Porretta M, Krajden S, Goldhar J, Diena BB. An autochthonous phaeohyphomycotic nail infection in Canada caused by Hendersonula toruloidea. J Mycoses. 1990;33(1):37-40. doi: 10.1111/myc.1990.33.1.37
Guo MM, Tseng WN, Ko CH, et al. Th17- and Treg-related cytokine and mRNA expression are associated with acute and resolving Kawasaki disease. J Allergy. 2015;70(3):310-318. doi: 10.1111/all.12558
Rasouli M, Heidari B, Kalani M. Downregulation of Th17 cells and the related cytokines with treatment in Kawasaki disease. J Immunol Lett. 2014;162(1 Pt A):269-275. doi: 10.1016/j.imlet.2014.09.017
Teeling JL, Jansen-Hendriks T, Kuijpers TW, et al. Therapeutic efficacy of intravenous immunoglobulin preparations depends on the immunoglobulin G dimers: studies in experimental immune thrombocytopenia. J Blood. 2001;98(4):1095-1099. doi: 10.1182/blood.v98.4.1095
Loomba RS. Comment on the paper by Su et al. entitled 'safety and efficacy of warfarin plus aspirin combination therapy for giant coronary artery aneurysm secondary to kawasaki disease: a meta-analysis'. J Cardiology. 2015;130(3):164-165. doi: 10.1159/000369879
Subspecialty Group of Cardiology et al. The expert consensus on diagnosis and acute-phase treatment of Kawasaki disease. J Zhonghua Er Ke Za Zhi. 2022;60(1):6-13. doi: 10.3760/cma.j.cn112140-20211018-00879
Fukazawa R, Kobayashi J, Ayusawa M, et al. JCS/JSCS 2020 Guideline on Diagnosis and Management of Cardiovascular Sequelae in Kawasaki Disease. J Circ. 2020;84(8):1348-1407. doi: 10.1253/circj.CJ-19-1094
Kobayashi T, Ayusawa M, Suzuki H, et al. Revision of diagnostic guidelines for Kawasaki disease (6th revised edition). J Pediatr Int. 2020;62(10):1135-1138. doi: 10.1111/ped.14326
Michihata N, Matsui H, Fushimi K, Yasunaga H. Guideline-Concordant Treatment of Kawasaki Disease With Immunoglobulin and Aspirin and the Incidence of Coronary Artery Aneurysm. J Clin Pediatr (Phila). 2015;54(11):1076-80. doi: 10.1177/0009922814566932
Asada D, Taura Y, Itoh H, Tatsumi Y. Acute gastrointestinal hemorrhage in Kawasaki disease occurring before aspirin therapy. J Pediatr Int. 2019;61(11):1177-1178. doi: 10.1111/ped.13989
Huang X, Huang P, Zhang L, et al. Is aspirin necessary in the acute phase of Kawasaki disease? J Paediatr Child Health. 2018;54(6):661-664. doi: 10.1111/jpc.13816
Dhanrajani A, Yeung R. Revisiting the role of steroids and aspirin in the management of acute Kawasaki disease. J Curr Opin Rheumatol. 2017;29(5):547-552. doi: 10.1097/BOR.0000000000000425
Chang LS, Kuo HC. The role of corticosteroids in the treatment of Kawasaki disease. J Expert Rev Anti Infect Ther. 2020;18(2):155-164. doi: 10.1080/14787210.2020.1713752
Furusho K, Kamiya T, Nakano H, et al. High-dose intravenous gammaglobulin for Kawasaki disease. Lancet. 1984;2(8411):1055-1058. doi: 10.1016/s0140-6736(84)91504-6
Morishita KA, Goldman RD. Kawasaki disease recognition and treatment. J Can Fam Physician. 2020;66(8):577-579. doi:
Miyata K, Kaneko T, Morikawa Y, et al. Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study. Lancet Child Adolesc Health. 2018;2(12):855-862. doi: 10.1016/S2352-4642(18)30293-1
Shin J, Lee H, Eun L. Verification of Current Risk Scores for Kawasaki Disease in Korean Children. J Korean Med Sci. 2017;32(12):1991-1996. doi: 10.3346/jkms.2017.32.12.1991
Committee for Child Medication, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Immunology, the Society of Pediatrics, Chinese Medical Association; Editorial Board, Chinese Journal of Pediatrics. Consensus on the application of glucocorticoid from relative experts in pediatric rheumatoid diseases(part 1). J Zhonghua Er Ke Za Zhi. 2018;56(3):166-173. doi: 10.3760/cma.j.issn.0578-1310.2018.03.003
Friedman KG, Jone PN. Update on the Management of Kawasaki Disease. J Pediatr Clin North Am. 2020;67(5):811-819. doi: 10.1016/j.pcl.2020.06.002
Miyata K, Kaneko T, Morikawa Y, et al. Efficacy and safety of intravenous immunoglobulin plus prednisolone therapy in patients with Kawasaki disease (Post RAISE): a multicentre, prospective cohort study. Lancet Child Adolesc Health. 2018;2(12):855-862. doi: 10.1016/S2352-4642(18)30293-1
Wardle AJ, Connolly GM, Seager MJ, Tulloh RM. Corticosteroids for the treatment of Kawasaki disease in children. J Cochrane Database Syst Rev. 2017;1(1):CD011188. doi: 10.1002/14651858.CD011188.pub2
Yu JJ. Use of corticosteroids during acute phase of Kawasaki disease. J World J Clin Pediatr. 2015;4(4):135-142. doi: 10.5409/wjcp.v4.i4.135
Fukunishi M, Kikkawa M, Hamana K, et al. Prediction of non-responsiveness to intravenous high-dose gamma-globulin therapy in patients with Kawasaki disease at onset. J Pediatr. 2000;137(2):172-176. doi: 10.1067/mpd.2000.104815
Cakan M, Gemici H, Aktay-Ayaz N, et al. Kawasaki disease shock syndrome: a rare and severe complication of Kawasaki disease. Turk J Pediatr. 2016;58(4):415-418. doi: 10.24953/turkjped.2016.04.012
Jiang DJ, Huang P, Zhang L. The research progress of Kawasaki disease shock syndrome. J Zhonghua Er Ke Za Zhi. 2016;54(12):961-963. doi: 10.3760/cma.j.issn.0578-1310.2016.12.020
Ma L, Zhang YY, Yu HG. Clinical Manifestations of Kawasaki Disease Shock Syndrome. J Clin Pediatr (Phila). 2018;57(4):428-435. doi: 10.1177/0009922817729483
Rassas A, Guizani R, Werdani A, Jammeli N, Mahjoub B. Kawasaki disease shock syndrome complicated by coronary aneurysms: a case report. J Pan Afr Med. 2021;38:52. doi: 10.11604/pamj.2021.38.52.27599
Garcia-Pavon S, Yamazaki-Nakashimada MA, Baez M, Borjas-Aguilar KL, Murata C. Kawasaki Disease Complicated With Macrophage Activation Syndrome: A Systematic Review. J Pediatr Hematol Oncol. 2017;39(6):445-451. doi: 10.1097/MPH.0000000000000872
Grom AA, Horne A, De Benedetti F. Macrophage activation syndrome in the era of biologic therapy. Nat Rev Rheumatol. 2016;12(5):259-268. doi: 10.1038/nrrheum.2015.179
Han SB, Lee SY. Macrophage activation syndrome in children with Kawasaki disease: diagnostic and therapeutic approaches. World J Pediatr. 2020;16(6):566-574. doi: 10.1007/s12519-020-00360-6
McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. J Circulation. 2017;135(17):e927-e999. doi: 10.1161/CIR.0000000000000484
Caplan A, Fett N, Rosenbach M, Werth VP, Micheletti RG. Prevention and management of glucocorticoid-induced side effects: A comprehensive review: Gastrointestinal and endocrinologic side effects. J Am Acad Dermatol. 2017;76(1):11-16. doi: 10.1016/j.jaad.2016.02.1239
Oray M, Abu SK, Ebrahimiadib N, Meese H, Foster CS. Long-term side effects of glucocorticoids. Expert Opin Drug Saf. 2016;15(4):457-465. doi: 10.1517/14740338.2016.1140743
Ritter A, Burow A, Vallelian F, Schaer D. [Systemic glucocorticoids: diagnosis, prophylaxis and treatment of side effects]. J Praxis. 2014;103(17):987-998. doi: 10.1024/1661-8157/a001747
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