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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: [email protected]
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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.

References

1. Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the young, American Heart Association. Pediatrics 2004; 114: 1708–1733.Google Scholar
2. Zheng, YZ, Du, ZD. Warfarin and aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease. Chin J Appl Clin Pediatr 2013; 28: 649–652.Google Scholar
3. Zhang, L, Zhang, MJ, Zhu, L, et al. Giant coronary artery aneurysm caused by Kawasaki disease observed by coronary angiography. Chin J Appl Clin Pediatr 2013; 28: 679–681.Google Scholar
4. Zhu, MH, Liang, M, Wang, ZJ, et al. Clinical similarities and differences in Kawasaki disease during 1991–2001 and 2002–2011 periods. Chin J Appl Clin Pediatr 2013; 28: 686–689.Google Scholar
5. Freeman, AF, Shulman, ST. Recently developments in Kawasaki disease. Current Opin Infect Dis 2001; 14: 357–361.CrossRefGoogle ScholarPubMed
6. Fudazawa, R, Oqawa, S. Long-term prognosis of patients with Kawasaki disease: at risk for future atherosclerosis. J Nippon Med Sch 2009; 76: 124–133.Google Scholar
7. Zhang, CY, Jin, HF, Du, JB. The significance of the level of plasma prealbumin in patients with Kawasaki diseases. J Chin Pediatr 2010; 28: 628–629.Google Scholar
8. Zhang, M, Hu, XF. Research of immunoglobulin-resistant Kawasaki disease. Chin J Appl Clin Pediatr 2013; 28: 1672–1675.Google Scholar
9. Zhang, YL, Du, ZD, Fu, PP. Therapy efficacy of different dose intravenous immunoglobulin and/or combined with methylprednisolone in non-response children with Kawasaki disease. Chin J Evid Based Pediatr 2013; 8: 220–223.Google Scholar
10. Tang, QQ. Recent advances in the treatment of Kawasaki disease. J Chin Pediatr 2013; 31: 488–490.Google Scholar
11. Hashino, K, Ishii, M, Iemura, M, et al. Re-treatment for immune globulin-resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. Pediatr Int 2001; 43: 211–217.CrossRefGoogle ScholarPubMed
12. Miura, M, Ohki, H, Yoshiba, S, et al. Adverse effects of methylprednisolone pulse therapy in refractory Kawasaki disease. Arch Dis Child 2005; 90: 1096–1097.Google Scholar
13. Miura, M, Kohno, K, Ohki, H, et al. Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin. Eur J Pediatr 2008; 167: 1119–1123.Google Scholar
14. Furukawa, T, Kishiro, M, Akimoto, K, et al. Effects of steroid pulse therapy on immunoglobulin-resistant Kawasaki disease. Arch Dis Child 2008; 93: 142–146.Google Scholar
15. Ogata, S, Bando, Y, Kimura, S, et al. The strategy of immune globulin resistant Kawasaki disease: a comparative study of additional immune globulin and steroid pulse therapy. J Cardiol 2009; 53: 15–19.CrossRefGoogle ScholarPubMed
16. Teraguchi, M, Ogino, H, Yoshimura, K, et al. Steroid pulse therapy for children with intravenous immunoglobulin in Kawasaki disease: a prospective study. J Pediatr Cardiol 2013; 34: 959–963.CrossRefGoogle ScholarPubMed
17. Yang, B, Zhu, YJ. Advances in epidemiology, etiology and pathogenesis of Kawasaki disease. J Chin Pediatr 2014; 32: 189–192.Google Scholar
18. Zhang, YL, Du, ZD, Yang, HM, et al. Experimental study of TNF-α/NF-κB/MMP-9 pathway in a murine model of Kawasaki disease. Chin J Evid Based Pediatr 2014; 9: 59–63.Google Scholar
19. Onouchi, Y, Suzuki, Y, Suzuki, H, et al. ITPKC and CASP3 polymorphisms and risks for intravenous immunoglobulin unresponsiveness and coronary artery lesion formation in Kawasaki disease. Pharmacogenomics J 2013; 13: 52–59.CrossRefGoogle ScholarPubMed
20. Galeotti, C, Bayry, J, Kone-Paut, I, et al. Kawasaki disease: aetiopathogenesis and therapeutic utility of intravenous immunoglobulin. Autoimmun Rev 2010; 9: 441–448.Google Scholar
21. Kobayashi, T, Saji, T, Otani, T, et al. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomized, open-label, blinded endpoints trial. Lancet 2012; 379: 1613–1620.Google Scholar
22. Kim, HK, On, J, Hong, YM, et al. Parameters to guide retreatment after initial intravenous immunoglobulin therapy in Kawasaki disease. Korean Circ J 2011; 41: 379–384.Google Scholar
23. Teraguchi, M, Ogino, H, Yoshimura, K, et al. Steroid pulse therapy for children with intravenous immunoglobulin therapy-resistant Kawasaki disease: a prospective study. Pediatr Cardiol 2013; 34: 959–963.CrossRefGoogle ScholarPubMed
24. Yan, H, Wan, H, Du, JB, et al. Risk factors and prediction analysis of intravenous immunoglobulin resistant Kawasaki disease. J Appl Clin Pediatr 2012; 27: 1637–1640.Google Scholar
25. Millar, K, Manlhiot, C, Yeung, RS, et al. Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression. Int J Cardiol 2012; 154: 9–13.Google Scholar
26. Wang, YQ, Cao, XJ. Updates on diagnosis and management of Kawasaki disease unresponsive to intravenous gamma globulin. Chin J Pediatr 2005; 43: 226–228.Google ScholarPubMed
27. Li, XH. Progress in diagnosis and treatment of Kawasaki disease. Chin J Appl Chin Pediatr 2013; 28: 9–13.Google Scholar
28. Miura, M, Tamame, T, Naganuma, T, et al. Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy. Paediatr Child Health 2011; 16: 479–484.Google Scholar
29. Hung, JJ, Chiu, CH. Pulse methylprednisolone therapy in the treatment of immune globulin-resistant Kawasaki disease: case report and review of the literature. Ann Trop Paediatr 2004; 24: 89–93.Google Scholar
30. Sundel, RP, Baker, AL, Fulton, DR, et al. Corticosteroids in the initial treatment of Kawasaki disease: report of a randomized trial. J Pediatr 2003; 142: 1137–1139.CrossRefGoogle ScholarPubMed
31. Zhu, BH, Lv, HT, Ling, S, et al. A meta-analysis on the effects of corticosteroid therapy in Kawasaki disease. Eur J Pediatr 2012; 171: 571–578.Google Scholar
32. Freeman, AF, Shulman, ST. Refractory Kawasaki disease. Pediatr Infect Dis 2004; 23: 463–464.Google Scholar