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Electrochemiluminescence Assays for Human Islet Autoantibodies
Published on: March 23, 2018
Analgesic antipyretic use among young children in the TEDDY study: no association with islet autoimmunity
Markus Lundgren1, Leigh Johnson Steed2, Roy Tamura3
1Department of Clinical Sciences, Diabetes and Celiac disease unit, Lund University, Clinical Research Centre, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. markus.lundgren@med.lu.se.
Insights
Analgesic antipyretic (ANAP) use in children is common, especially in the U.S. ANAP use before age 6 does not increase the risk of islet autoimmunity, though fever-related acetaminophen use showed a weak association by age 3.
Area of Science:
- Pediatrics
- Pharmacology
- Immunology
Background:
- Analgesic antipyretic (ANAP) use in children is controversial due to limited individual-level data.
- Potential effects of ANAP on glucose homeostasis and immune function warrant investigation.
Purpose of the Study:
- To analyze patterns of ANAP use in young children across TEDDY study centers.
- To determine if ANAP use is a risk factor for developing islet autoimmunity.
Main Methods:
- Prospective cohort study of 8542 children up to 2.5 years of age.
- Logistic regression and Cox proportional hazards models analyzed ANAP use and seroconversion.
- Generalized estimating equation approach used for categorizations.
Main Results:
- ANAP prevalence was higher in the U.S. (95.7%) and Sweden (94.8%) vs. Finland (78.1%) and Germany (80.2%).
- Acetaminophen use was more common in first-borns; NSAID use was less common.
- ANAP use without fever/infection was highest in the U.S. (40.4%).
- ANAP use before 2.5 years did not predict islet autoimmunity by age 6.
- Acetaminophen use with fever weakly predicted islet autoimmunity by age 3.
Conclusions:
- Widespread ANAP use in young children, particularly in the U.S., often occurs without fever or infection.
- ANAP use in early childhood is not a significant risk factor for islet autoimmunity by age 6.
- A weak association exists between acetaminophen use during fever and islet autoimmunity by age 3.
Background:
The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity.
Methods:
Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used.
Results:
Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024).
Conclusions:
ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.
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