While the treatment of Kawasaki disease (KD) with a single infusion of intravenous immunoglobulin (IVIG) has been well established, the optimal dose of acetyl-salicylic acid (ASA) for treating KD remains unclear.

For a study published in Arthritis Care & Research, Anita Dhanrajani, MD, and colleagues examined patients with KD from two medical centers to assess the impact of ASA dose on IVIG resistance. the research team used standard IVIG dosing, with one center using low-dose ASA starting at diagnosis (3-5 mg/kg/day) and the other using initial high-dose ASA (80-100 mg/kg/day). No significant differences in baseline characteristics existed between patients treated at the two centers.

Re-treatment with a second dose of IVIG was required in 23.0% of patients treated with low-dose ASA, compared with 8.7% of those treated with high-dose ASA. After adjusting for confounders, low-dose ASA was associated with higher odds of IVIG resistance. The mean durations of hospital stay were 4.1 and 4.7 days for those treated with low- and high-dose ASA, respectively. Coronary artery aneurysms were seen in 1.7% of patients treated low-dose ASA and 4.8% of those treated with high-dose ASA.

“In contrast to a previous study that reported no difference in IVIG resistance between high dose and no aspirin, we detected a 3 times increased odds of IVIG resistance in the low dose aspirin group compared to the high dose aspirin group in our study,” says Dr. Dhanrajani.

References

Chan, M, Dhanrajani, A, Pau, S, et al. Aspirin dose in Kawasaki disease – the ongoing battle. Arthritis Care Res. December 2017 [Epub ahead of print]. Available at https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23504.