Higher efficacy of infliximab than immunoglobulin on Kawasaki disease, a meta-analysis

Li, Xuan; Tang, Yunjia; Ding, Yueyue; Chen, Ye; Miao, Heng; Qian, Guanghui; Qin, Li–Qiang; Lv, Haitao

doi:10.1016/j.ejphar.2021.173985

Cited by 2 publications

(5 citation statements)

References 31 publications

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“…A previous review by Yamaji et al reported that TNF‐α blockers (infliximab and etanercept) compared with placebo or additional IVIG treatment might be effective for treatment resistance and might decrease infusion reactions and found no difference in CAA incidence between treatment groups 14 . Another metanalysis by Xuan et al reported that infliximab use as a first‐line treatment in KD or as a treatment for IVIG‐resistant KD was effective in reducing fever and infusion reactions but not CAAs 15 . An indirect meta‐analysis by Chan et al reported that in comparison with the second dose of IVIG, infliximab did not reduce the incidence of CAAs or treatment resistance in patients with refractory KD 32 .…”

Section: Discussionmentioning

confidence: 99%

“…14 Another metanalysis was conducted by Li-Jun Xu et al to evaluate the effect of TNF blockers in refractory KD, which included five retrospective studies on infliximab. 15 The results showed that TNF blockers could shorten the duration of fever with no cardioprotective effect observed in refractory KD. 15 Given the limited evidence, the effect of infliximab as second-line therapy in patients with refractory KD is still inconclusive.…”

Section: Description Of the Interventionmentioning

confidence: 97%

“…15 The results showed that TNF blockers could shorten the duration of fever with no cardioprotective effect observed in refractory KD. 15 Given the limited evidence, the effect of infliximab as second-line therapy in patients with refractory KD is still inconclusive. As the clinical evidence has increased, we conducted this systematic review to evaluate the safety and impact of infliximab use as second-line therapy on the incidence of CAAs and treatment resistance in children with refractory KD.…”

Section: Description Of the Interventionmentioning

confidence: 97%

“…14 Another metanalysis by Xuan et al reported that infliximab use as a first-line treatment in KD or as a treatment for IVIG-resistant KD was effective in reducing fever and infusion reactions but not CAAs. 15 An indirect meta-analysis by Chan et al reported that in comparison with the second dose of IVIG, infliximab did not reduce the incidence of CAAs or treatment resistance in patients with refractory KD. 32 This review showed that infliximab compared to the second dose of IVIG reduced the incidence of treatment resistance.…”

Section: Agreements and Disagreements With Other Studies Or Reviewsmentioning

confidence: 99%

“…Another metanalysis was conducted by Li‐Jun Xu et al to evaluate the effect of TNF blockers in refractory KD, which included five retrospective studies on infliximab 15 . The results showed that TNF blockers could shorten the duration of fever with no cardioprotective effect observed in refractory KD 15 …”

Section: Introductionmentioning

confidence: 99%

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Infliximab as a second‐line therapy for children with refractory Kawasaki disease: A systematic review and meta‐analysis of randomized controlled trials

Kabbaha

Milano

Aldeyab

et al. 2022

Brit J Clinical Pharma

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Aims Infliximab is a tumour necrosis factor‐alpha inhibitor that is used to treat children with refractory Kawasaki disease (KD). Our purpose was to evaluate the safety and impact of infliximab versus intravenous immunoglobulins on the incidence of coronary artery aneurysms (CAAs) and treatment resistance in children with refractory KD. Methods The Medline/PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials and clinical trials registries were searched to December 2021. Randomized controlled trials (RCTs) comparing infliximab as second‐line therapy to a second dose of intravenous immunoglobulin (IVIG) in children with refractory KD, reported in abstract or full text, were included. Studies were selected and assessed for risk of bias by two reviewers. Data were extracted and pooled using conventional random‐effects meta‐analysis. The certainty of evidence was assessed using the GRADE system. Results A total of 199 participants from four RCTs were included. The pooled risk ratio (RR) for the incidence of treatment resistance in patients treated with infliximab was 0.40 (95% confidence interval [CI] 0.25‐0.64). For incidence of CAAs RR was 1.20 (95% CI 0.54‐2.63), the incidence of adverse effect “infusion reactions” RR was 0.48, (95% CI 0.12‐1.92) and for “infections” RR was 0.55 (95% CI 0.27‐1.12). Overall, the GRADE strength of evidence for the primary outcomes was low. Evidence on the duration of fever and inflammatory biomarkers was sparse, heterogeneous and inconclusive. Conclusion Moderate‐certainty evidence indicates that infliximab may reduce the incidence of treatment resistance in children with refractory KD. However, the limited strength of evidence warrants further research.

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Section: Discussionmentioning

confidence: 99%

Section: Description Of the Interventionmentioning

confidence: 97%

Section: Description Of the Interventionmentioning

confidence: 97%

Section: Agreements and Disagreements With Other Studies Or Reviewsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Infliximab as a second‐line therapy for children with refractory Kawasaki disease: A systematic review and meta‐analysis of randomized controlled trials

Kabbaha

Milano

Aldeyab

et al. 2022

Brit J Clinical Pharma

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Have we got the optimal treatment for refractory Kawasaki disease in very young infants? A case report and literature review

Lersch,

Mandilaras,

Schrader

et al. 2023

Front. Pediatr.

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A small group of patients with Kawasaki disease (KD) demonstrates resistance to standard therapy, putting them at high risk for an unfavorable prognosis, especially regarding coronary artery aneurysms. Although adding corticosteroids to first-line i.v. immunoglobulins (IVIGs) is considered beneficial, and despite timely treatment initiation, very young infants, in particular, can present an unfavorable clinical course. We report on a 3-month-old boy with a clinically severe KD phenotype involving the early development of giant coronary artery aneurysms. Because of his poor response to the first course of IVIG and prednisolone, we administered infliximab. His clinical condition improved after that, and his temperature dropped. Inflammatory markers however did not recover completely, and he remained subfebrile. In addition, as the coronary artery dimensions deteriorated, a second IVIG course was administered and prednisolone continued at the initial dosage. Although fever and routine inflammatory parameters normalized, close follow-up investigations revealed both still increasing coronary artery dimensions and renewed rise in inflammatory parameters, necessitating two more infliximab administrations in addition to continuous prednisolone. Because of the coronary artery dimensions (left anterior descending artery, 4.9 mm, Z-score 11.1; right coronary artery 5.8 mm, Z-score 15.5), dual platelet inhibitory therapy with ASA and later clopidogrel combined with low-molecular heparin was indicated. Four weeks after his initial KD diagnosis, we detected no renewed increase in inflammatory markers; at that time, we observed a slight reduction in coronary dimensions. In summary, despite timely guideline-fulfilling therapy, the prolonged clinical course of this very young infant with KD entailing the development of giant coronary artery aneurysms makes us question whether this age group may benefit from early, even more intense therapy.

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Higher efficacy of infliximab than immunoglobulin on Kawasaki disease, a meta-analysis

Cited by 2 publications

References 31 publications

Infliximab as a second‐line therapy for children with refractory Kawasaki disease: A systematic review and meta‐analysis of randomized controlled trials

Infliximab as a second‐line therapy for children with refractory Kawasaki disease: A systematic review and meta‐analysis of randomized controlled trials

Have we got the optimal treatment for refractory Kawasaki disease in very young infants? A case report and literature review

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