Meta Analysis Of Infliximab In The Treatment Of IVIG-resistant Kawasaki Diease

Objective: The current standard treatment for kawasaki disease is the use of large doses of immunoglobulin 2g/(kg.d)combined with aspirin,but still 10% to 20% of children do not respond to IVIG.This study used meta-analysis of evidence-based medicine to evaluate the efficacy and safety of infliximab in IVIG-resistant kawasaki patients.Methods: By searching the main literature databases at home and abroad,a total of 5 literatures were selected on the comparative treatment of two kinds of treatment schemes for the IVIG-resistant kawasaki disease treated by intravenous injection of gamma globulin.We used a meta-analysis for statistical comparison of coronary artery lesions,response rate after retreatment,average of hospitalization time,and incidence of adverse events.Results: The 5 studies included 292 patients,of whom 81 were treated with infliximab(the infliximab group)and 211 were intravenous immunoglobulin(the IVIG group).Results:(1)Compared with IVIG group,the Infliximab group can be more effective defervescence,clinical symptoms improved faster(OR = 4.08,95% CI: 1.93 ~ 8.62,P = 0.0002)and had shorter hospital stay(MD = 1.09,95% CI: 2.04 ~ 0.13,P = 0.03),(2)In the continued treatment of IVIG reactive kawasaki disease,infliximab did not reduce the incidence of coronary artery damage.The incidence of coronary artery lesions(OR = 0.57,95%ci: 0.21 ~ 1.54,P =0.27 > 0.05)and the incidence of coronary artery aneurysm(OR = 1.44,95%ci: 0.59 ~ 3.53,P =0.43 > 0.05)were similar between the two groups.(3)the incidence of adverse events was similar between the two groups(OR = 0.63,95%ci: 0.21~1.84,P=0.39).Conclusion: The incidence of adverse events was similar to that of coronary artery abnormalities between the two groups treated with infliximab and IVIG,but the infliximab group was superior in terms of antipyretic effect and length of stay after treatment.