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A meta-analysis of re-treatment for intravenous immunoglobulin-resistant Kawasaki disease

Published online by Cambridge University Press:  19 January 2015

Xi Yang ,
Guiying Liu ,
Yaqian Huang ,
Stella Chen ,
Junbao Du  and
Hongfang Jin
Xi Yang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China Department of Pediatrics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Guiying Liu
Affiliation:
Department of Pediatrics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Yaqian Huang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Stella Chen
Affiliation:
Department of Biochemistry and Cellular Biology, University of California, San Diego, California, United States of America
Junbao Du
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
Hongfang Jin*
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
*
Correspondence to: Professor H. Jin, Department of Pediatrics, Peking University First Hospital, Beijing 100034, China. Tel: +86 10 66530532; Fax: +86 10 66530532; E-mail: jinhongfang51@126.com
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Abstract

Objective

To determine the optimal drug therapy for intravenous immunoglobulin-resistant Kawasaki disease.

Methods

Studies regarding drug therapy for intravenous immunoglobulin-resistant Kawasaki disease were selected from medical electronic databases including PubMed, Medline, Elsevier, and Springer Link. The effectiveness in terms of temperature recovery and coronary artery damage was compared between a second intravenous immunoglobulin treatment and glucocorticosteroid treatment for children with intravenous immunoglobulin-resistant Kawasaki disease using meta-analysis with Review Manager 5.3 software. Indices to evaluate the effects were body temperature, biomarker levels, and coronary artery lesions detected by echocardiography. Results are reported as relative risks or odds ratio with a 95% confidence interval and p<0.05.

Results

Meta-analysis included 52 patients in the second intravenous immunoglobulin treatment group and 75 patients in the glucocorticosteroid treatment control group from four studies that met our inclusion criteria. Temperatures of patients who received glucocorticosteroid treatment were effectively controlled compared with those who received a second intravenous immunoglobulin treatment (relative risk=0.73, 95% confidence interval: 0.58–0.92, p=0.007). There were no differences, however, in the incidence of coronary artery lesions between the two groups (odds ratio=1.55, 95% confidence interval: 0.57–4.20, p=0.39).

Conclusions

Glucocorticosteroids are more effective in controlling body temperature compared with intravenous immunoglobulin re-treatment in intravenous immunoglobulin-resistant Kawasaki disease children; however, glucocorticosteroids and intravenous immunoglobulin re-treatment showed no difference in the prevention of coronary artery lesions.

Keywords

Mucocutaneous lymph node syndromeKawasaki diseaseintravenous immunoglobulinglucocorticosteroidmeta-analysis
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015 , pp. 1182 - 1190
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Copyright
© Cambridge University Press 2015 

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Footnotes

a

They contributed equally to this work.

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