Effect and Safety of TNF Inhibitors in Immunoglobulin-Resistant Kawasaki Disease: a Meta-analysis

Xue, Lijun; Wu, Rong; Du, Gui-Lian; Xu, Yan; Yuan, Kang-Yan; Feng, Zhichun; Pan, Yu-Lin; Hu, Guangyu

doi:10.1007/s12016-016-8581-4

Cited by 26 publications

(11 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2012, Callinan reported a higher CAL incidence of 19% in California ( 21 ). Several studies have been conducted in order to reduce the occurrence of CAL, for example involving adjunctive corticosteroid therapy, different doses of aspirin, and tumor necrosis factor inhibitors in immunoglobulin-resistant KD ( 3 , 38 , 39 ). Unfortunately, they all failed to find convincing positive results.…”

Section: Discussionmentioning

confidence: 99%

“…In severe cases, giant coronary artery aneurysms or coronary artery ectasia can develop, which is the leading cause of acquired heart disease ( 1 , 2 ). Intravenous immunoglobulin (IVIG) therapy is the first-line treatment of KD with well-established therapeutic effects in preventing coronary artery abnormalities ( 3 ). Coronary artery aneurysms (CAAs) develop in ~25% of untreated patients ( 4 ); however, in patients receiving a timely high dose of IVIG, it is reported that only about 5% of patients ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: In the latest 2017 American Heart Association guidelines for Kawasaki disease (KD), there are no recommendations regarding the early administration of intravenous immunoglobulin (IVIG). Therefore, the purpose of this systematic review and meta-analysis was to investigate the effects of early IVIG therapy on KD.Methods: We searched databases including the PubMed, Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2019.Results: Fourteen studies involving a total of 70,396 patients were included. Early treatment with IVIG can lead to an increased risk of IVIG unresponsiveness [OR 2.24; 95% CI (1.76, 2.84); P = 0.000]. In contrast to the studies performed in Japan [OR 1.27; 95% CI (0.98, 1.64); P = 0.074] that found no significant difference in coronary artery lesions (CAL) development, studies conducted in China [OR 0.73; 95% CI (0.66, 0.80); P = 0.000] and the United States [OR 0.50; 95% CI (0.38, 0.66); P = 0.000] showed a reduced risk in the occurrence of CAL with early IVIG treatment.Conclusions: At present, the evidence does not support the treatment with IVIG in the early stage of the onset of KD. But, early IVIG treatment could be a protective factor against the development of CAL, which needs to be further clarified.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, the lack of sufficient clinical trials regarding this topic, as well as the small number of subjects included in the available trials, may have led to bias. A meta-analysis in 2017 [32] that included only 4 studies (2 RCTs of immunoglobulin-resistant KD patients, 1 RCT of initial treatment for KD patients, and 1 case-control study) showed that with the exception of antipyretic action, infliximab did not provide significantly more benefit than second IVIG with respect to the cardioprotective effect, rate of treatment resistance, and total rate of AEs. The authors took full advantage of the limited literature in this meta-analysis and merged data from studies with different designs.…”

Section: Discussionmentioning

confidence: 99%

Indirect-comparison meta-analysis of treatment options for patients with refractory Kawasaki disease

et al. 2019

View full text Add to dashboard Cite

Background There is limited information available regarding the clinical management of intravenous immunoglobulin-resistant Kawasaki disease (KD). We aimed to evaluate the optimal treatment options for patients with refractory KD by presenting an indirect-comparison meta-analysis. Methods PubMed, EMBASE, Web of Science, and the Cochrane Database were searched on August 31, 2018. Unpublished studies were also searched in ProQuest Dissertations & Theses and through manual retrieval strategies. Randomized concurrent controlled trials (RCTs), high-quality non-randomized concurrent controlled trials (non-RCTs), and retrospective studies associated with AEs were included. The quality of all eligible studies was assessed using Cochrane collaboration’s tool and non-randomized study guidelines. Risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes were estimated in our analysis. GRADE profiler 3.6.1 was used to assess the evidence profile. Results Twelve studies involving 372 immunoglobulin-resistant KD patients were identified and analyzed. Neither infliximab nor intravenous pulse methylprednisolone (IVMP) was significantly more effective than second IVIG infusion with respect to lowering coronary artery lesions (CALs) (infliximab, 0.85, 0.43–1.69; IVMP, 0.99, 0.52–1.88) and treatment resistance (infliximab, 0.43, 0.21–0.89; IVMP, 1.16, 0.33–4.13). No significant differences were found between infliximab and IVMP in the incidence rate of CALs (0.70, 0.27–1.81), the treatment resistance (0.37, 0.09–1.60), the rates of coronary artery aneurysm (4.13, 0.38–45.22) and the coronary artery dilatation (0.45, 0.10–1.99). Furthermore, compared with second IVIG infusion, both infliximab and IVMP showed significant effectiveness in antipyretic effects (infliximab, 1.52, 1.16–1.99; IVMP, 1.29, 0.77–2.15). However, Infliximab was noninferior to IVMP on antipyretic effects (1.18, 0.66–2.15). IVMP treatment showed significant association with fewer AEs than second IVIG infusion (0.49, 0.26–0.94) and infliximab (2.34, 1.07–5.09). No significant differences were noted between infliximab treatment and second IVIG infusion (1.06, 0.69–1.63). Conclusions Infliximab, IVMP, and second IVIG infusion showed no significant differences in the cardioprotective effect or the rate of treatment resistance. Infliximab and IVMP treatment were more effective than second IVIG infusion regarding antipyretic effects. IVMP treatment may have an advantage due to its lower total rate of AEs associated with drug infusion. Trial registration The study has been registered on PROSPERO ( CRD42016039693 ). Electronic supplementary material The online version of this article (10.1186/s12887-019-1504-9) contains supplementary material, which is available to authorized users.

show abstract

“…Also, according to a study on KD pathogenesis, children suffering from the disease presented with significantly elevated levels of TNFα. In addition, anti-TNFα was tested in the treatment of KD and showed significant improvement [45].…”

Section: Cytokine Profile In Both Disorders Innate Immunity Cytokinesmentioning

confidence: 99%

Unleashing the mysterious link between COVID-19 and a famous childhood vasculitis: Kawasaki disease

AbdelMassih

AbdelAzeam

Ayad

et al. 2020

Egypt Pediatric Association Gaz

View full text Add to dashboard Cite

Background: Coronavirus disease 2019 (COVID-19) emerged as a small outbreak in Wuhan rapidly progressing into the deadliest pandemic since the Spanish flu of 1918. The disease was deemed trivial in children, until the reporting, few days ago, of an emerging pediatric multi-inflammatory syndrome mimicking Kawasaki disease (KD). Main body: This report reveals that coronaviridae were implicated in induction of several post-infectious vasculitides, namely, KD, AHEI, and HSP. This occurs in genetically susceptible individuals to vascular inflammation. Shared genetic susceptibilities between KD and CoV include genes encoding for CD 40, HLAB-15:03, and ACE. This leads to augmented inflammation with hypersecretion of cytokines especially IL-6. Conclusion: The revealed relationships between KD and CoV can help to predict the risk of KD in COVID-19 patients through screening levels of upregulated cytokines. It might also signify that classic treatment of KD with IVIG might need to be replaced with anti-cytokine therapy in COVID-19 patients.

show abstract

Effect and Safety of TNF Inhibitors in Immunoglobulin-Resistant Kawasaki Disease: a Meta-analysis

Cited by 26 publications

References 44 publications

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

Indirect-comparison meta-analysis of treatment options for patients with refractory Kawasaki disease

Unleashing the mysterious link between COVID-19 and a famous childhood vasculitis: Kawasaki disease

Contact Info

Product

Resources

About