Kawasaki Disease Treatment with Intravenous Immunoglobulins and Aspirin and Options to Treat Resistant Disease: Second Dose of Intravenous Immunoglobulins, Glucocorticoid Pulse Therapy, Infliximab and Anakinra
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Hipotēzes
1. Primārajā Kavasaki slimības terapijā intravenozais imunoglobulīns (IVIG) monoterapijā ir pietiekoši efektīgs salīdzinājumā ar iepriekš rekomendēto IVIG un augstu devu acetilsalicilskābes kombināciju. Terapija ar augstu devu acetilsalicilskābi nav nepieciešama.
2. Labākā izvēle IVIG refraktāras Kavasaki slimības gadījumā nav atkārtota IVIG ievadīšana, bet gan glikokortikoīdu pulsa terapija.
Mērķis
Izvērtēt primāro Kavasaki slimības terapiju attiecībā uz augstu devu acetilsalicilskābes lietošanu, kā arī noskaidrot IVIG refraktāras Kavasaki slimības terapijas iespējas.
Uzdevumi
1. Veikt literatūras apskatu, lai noskaidrotu vai Kavasaki slimības primārajā ārstēšanā drudža laikā nepieciešams lietot augstu devu aspirīnu, kā līdz šim rekomendējusi Amerikas Sirds asociācija (American Heart Association- AHA). Pacientu grupās, kas saņem augstu devu aspirīnu salīdzinājumā ar tiem, kas saņem mazu devu aspirīnu vai to nesaņem vispār, tiks vērtēti sekojoši parametri- drudzis, iekaisuma rādītāji, koronāro artēriju bojājumi, hospitalizācijas dienu skaits, ietekme uz iekaisuma procesu, IVIG rezistence, komplikāciju attīstības risks.
2. Izpētīt literatūru attiecībā uz terapijas iespējām IVIG rezistentas Kavasaki slimības gadījumā. Tiks salīdzinātas pacientu grupas, kas saņem atkārtotu IVIG terapiju ar pacientiem, kas saņem glikokortikoīdu pulsa terapiju, analizējot drudža mazināšanos, iekaisuma rādītāju dinamiku, koronāro artēriju bojājumu, medikamentu blaknes, efektivitāti un drošību. Līdzīgi tiks izvērtētas arī trešās rindas terapijas iespējas- infliksimabs un anakinra.
Secinājumi
1. Augstu devu aspirīna lietošana primārajā Kavasaki slimības terapijā nav nepieciešama.
2. IVIG refraktāras Kavasaki slimības gadījumā augsta riska pacientiem indicēta glikokortikoīdu pulsa terapija, savukārt zema riska pacientus vajadzētu ārstēt ar atkārtotu IVIG ievadi. Infliksimabs un anakinra, iespējams, ir droši un efektīgi medikamenti, tomēr nepieciešami apstiprinoši pētījumi.
Hypothesis 1. In the primary treatment of Kawasaki disease, IVIG alone is as effective as the long-established combination treatment of IVIG and high dose acetylsalicylic acid. High dose aspirin is not needed in the primary treatment of Kawasaki disease. 2. The best treatment choice of resistant Kawasaki disease is not the re-treatment with IVIG, rather glucocorticoid pulse therapy. Aims The aim of the study is an evaluation of the primary treatment of Kawasaki disease, regarding high dose aspirin, as well as, an assessment of the treatment of IVIG refractory KD. Main tasks 1. The literature review will be done, to determine whether the recommended treatment of the American Heart Association, concerning high dose aspirin is needed. The duration of fever, changes of inflammatory markers, incidence of coronary artery lesions, days of hospitalization, effect on the inflammation process, prevention of resistance and the risk of complications will be analyzed in two groups of patients - one receiving high dose aspirin and the other low dose or none. 2. To study the literature about treatment choices of refractory Kawasaki disease. Patient groups receiving IVIG re-treatment will be compared with groups receiving corticosteroid pulse therapy, focusing on defervescence, inflammatory markers, prevention of coronary artery lesions, adverse reactions, effectiveness and safety. Third line treatment options, infliximab and anakinra will be evaluated in the same manner. Conclusions 1. High dose aspirin is not needed in the primary treatment of KD. 2. In case of refractory KD, high-risk patients should receive corticosteroid pulse therapy, while low-risk patients should be treated with a second dose IVIG. Infliximab and anakinra seem to be safe and effective but further prospective studies are needed for evaluation.
Hypothesis 1. In the primary treatment of Kawasaki disease, IVIG alone is as effective as the long-established combination treatment of IVIG and high dose acetylsalicylic acid. High dose aspirin is not needed in the primary treatment of Kawasaki disease. 2. The best treatment choice of resistant Kawasaki disease is not the re-treatment with IVIG, rather glucocorticoid pulse therapy. Aims The aim of the study is an evaluation of the primary treatment of Kawasaki disease, regarding high dose aspirin, as well as, an assessment of the treatment of IVIG refractory KD. Main tasks 1. The literature review will be done, to determine whether the recommended treatment of the American Heart Association, concerning high dose aspirin is needed. The duration of fever, changes of inflammatory markers, incidence of coronary artery lesions, days of hospitalization, effect on the inflammation process, prevention of resistance and the risk of complications will be analyzed in two groups of patients - one receiving high dose aspirin and the other low dose or none. 2. To study the literature about treatment choices of refractory Kawasaki disease. Patient groups receiving IVIG re-treatment will be compared with groups receiving corticosteroid pulse therapy, focusing on defervescence, inflammatory markers, prevention of coronary artery lesions, adverse reactions, effectiveness and safety. Third line treatment options, infliximab and anakinra will be evaluated in the same manner. Conclusions 1. High dose aspirin is not needed in the primary treatment of KD. 2. In case of refractory KD, high-risk patients should receive corticosteroid pulse therapy, while low-risk patients should be treated with a second dose IVIG. Infliximab and anakinra seem to be safe and effective but further prospective studies are needed for evaluation.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Kavasaki slimības, intravenozā imunoglobulīna, aspirīn, glikokortikoīdu pulsa terapija, infliksimabs, anakinra, atkārtota IVIG, refraktāras Kavasaki slimības, Kawasaki disease, intravenous immunoglobulins, aspirin, glucocorticoid pulse therapy, infliximab, anakinra, second dose of intravenous immunoglobulins, resistant Kawasaki disease