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<p>This study aims to evaluate the impact of early steroid discontinuation on total dosage and outcomes in pediatric immunoglobulin A (IgA) vasculitis patients with uncontrolled abdominal pain. This retrospective cohort study included children younger than 16&#xa0;years with newly diagnosed IgA vasculitis hospitalized for abdominal pain who received their first dose of steroids between April 1, 2013, and March 31, 2019, at 14 hospitals. Patients were divided into two groups: the standard (STD) group, which received steroid therapy for at least 8 consecutive days, and the early discontinuation attempt (EDA) group, which attempted discontinuation within 7&#xa0;days. EDA was further divided into two subgroups: the early discontinuation (ED) group, which completed steroid treatment within a week, and the readministration (RA) group, which required readministration. Total steroid dosage, duration of therapy, hospital stay, and complications were compared. A total of 272 patients were analyzed: STD (<i>n</i> = 190) and EDA (<i>n</i> = 82). There were no significant differences in baseline characteristics. EDA had a shorter hospital stay (8.5 vs. 15.0&#xa0;days, <i>p</i> &lt; 0.01), fewer total steroid days (6 vs. 17.5&#xa0;days, <i>p</i> &lt; 0.01), and lower total steroid dosage (5.4&#xa0;mg/kg vs. 15.4&#xa0;mg/kg, <i>p</i> &lt; 0.01) compared to STD, with no significant differences in complications. Among EDA patients, 22 (27%) required steroid readministration due to symptom recurrence; however, symptoms resolved in all RA patients, with lower total steroid dosage and duration compared to STD, without prolonging hospital stay. </p><p><i>Conclusion</i>: Discontinuing steroids within 7&#xa0;days for abdominal pain in children with IgA vasculitis reduces total steroid dosage without increasing complications, even with occasional readministration. </p><p><i>Clinical trial registration</i>: Approval no. 2019–0394.</p>

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Early discontinuation of steroid treatment in children with abdominal pain due to IgA vasculitis

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  • 发表日期：

    2025年4月4日

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  • Sumika Kambara,
  • Nobuhiro Nishio,
  • Yuichiro Sugiyama,
  • Yosuke Nishio,
  • Yukina Takamoto,
  • Fumie Kitai,
  • Yuma Takahashi,
  • Nozomi Hayashi,
  • Kazunori Haruta,
  • Maki Kondo,
  • Naoko Oike,
  • Takeshi Miwa,
  • Nobuhiro Watanabe,
  • Marei Omori,
  • Fumie Kinoshita,
  • Taiki Furukawa,
  • Jun-ichi Kawada,
  • Hiroyuki Kidokoro,
  • Yoshiaki Sato,
  • Yoshiyuki Takahashi,
  • Kazuto Ueda,
  • Makoto Oshiro,
  • Atsushi Tashiro,
  • Kazuki Yamamori,
  • Motohiro Shibata,
  • Shinji Hasegawa,
  • Naoko Nishimura,
  • Masashi Morishita,
  • Michio Suzuki,
  • Tetsuo Kubota,
  • Noriko Nagai,
  • Osamu Shinohara,
  • Satoru Doi,
  • Mitsuharu Kajita,
  • Shinya Hara,
  • Takashi Kawabe,
  • Shin Hoshino

摘要

This study aims to evaluate the impact of early steroid discontinuation on total dosage and outcomes in pediatric immunoglobulin A (IgA) vasculitis patients with uncontrolled abdominal pain. This retrospective cohort study included children younger than 16 years with newly diagnosed IgA vasculitis hospitalized for abdominal pain who received their first dose of steroids between April 1, 2013, and March 31, 2019, at 14 hospitals. Patients were divided into two groups: the standard (STD) group, which received steroid therapy for at least 8 consecutive days, and the early discontinuation attempt (EDA) group, which attempted discontinuation within 7 days. EDA was further divided into two subgroups: the early discontinuation (ED) group, which completed steroid treatment within a week, and the readministration (RA) group, which required readministration. Total steroid dosage, duration of therapy, hospital stay, and complications were compared. A total of 272 patients were analyzed: STD (n = 190) and EDA (n = 82). There were no significant differences in baseline characteristics. EDA had a shorter hospital stay (8.5 vs. 15.0 days, p < 0.01), fewer total steroid days (6 vs. 17.5 days, p < 0.01), and lower total steroid dosage (5.4 mg/kg vs. 15.4 mg/kg, p < 0.01) compared to STD, with no significant differences in complications. Among EDA patients, 22 (27%) required steroid readministration due to symptom recurrence; however, symptoms resolved in all RA patients, with lower total steroid dosage and duration compared to STD, without prolonging hospital stay.

Conclusion: Discontinuing steroids within 7 days for abdominal pain in children with IgA vasculitis reduces total steroid dosage without increasing complications, even with occasional readministration.

Clinical trial registration: Approval no. 2019–0394.