Efficacy of infliximab in the treatment of Kawasaki disease: A systematic review and meta‑analysis

Abstract

The present study aimed to review the relevant studies in order to determine the efficacy of infliximab (IFX) in the treatment of Kawasaki disease (KD). The relevant studies were retrieved using the PubMed, Cochrane and Embase databases. Key sources in the literature were reviewed; all articles published by July 2019 were considered for inclusion. For each study, odds ratios, mean difference and 95% confidence interval (95% CI) were assessed to evaluate study outcomes. A total of 16 studies involving 429 patients were relevant to the questions of interest of the current meta-analysis. Compared with intravenous immunoglobulin (IVIG), IFX or IFX plus IVIG significantly reduced the incidence of adverse events, including the number of patients with fever, changes in lip and oral cavity and/or cervical lymphadenopathy. The white blood cell (WBC), neutrophil and C-reactive protein (CRP) levels were also reduced in the IFX or IFX plus IVIG group compared with those in the IVIG or polyethylene glycol-treated human immunoglobulin (VGIH) groups. The platelet counts, alanine aminotransferase (ALT) levels and Z-scores were increased in the IFX or IFX plus IVIG groups compared with those in the IVIG or VGIH groups. In the single-arm studies, the incidence of coronary artery aneurysm was 0.150 (95% CI: 0.024, 0.277), the non-response rate was 0.097 (95% CI: 0.056, 0.138), and the incidence of adverse events was 0.156 (95% CI: 0.122, 0.190). IFX not only effectively reduced the incidence of fever, conjunctival injection, changes in lip and oral cavity and cervical lymphadenopathy polymorphous exanthema, but also the WBC, neutrophil, ALT and CRP levels. The platelet levels were increased in patients after the IFX therapy compared with patients in the IVIG or VGIH groups. IFX or IFX plus IVIG exhibited improved clinical efficacy in the treatment of KD compared with that of IVIG or VGIH. However, as a limited number of studies was included in the current study, the findings should be verified further.

Kawasaki like illness due to COVID-19: a review of the literature

“…Pooled data from 16 studies involving 429 patients was analysed, with infliximab treatment causing less complications such as fever, mucosal lesions and lymphadenopathy in the cervical region as compared to traditional immunoglobulin treatment. Laboratory results also showed more significant improvement in platelet count and inflammatory markers such as C-reactive protein and white cell counts in the infliximab groups as compared to the immunoglobulin groups [15]. Similar benefits were noted in groups receiving combination therapy with infliximab and immunoglobulins, further supporting the potential benefit of infliximab in KD treatment [16].…”

“…Tumor necrosis factor-alpha (TNF-α) levels are raised more significantly in KD patients who develop coronary artery aneurysms as compared to those without. This could be related to TNF-α triggering the release of chemokines by endothelial cells, increasing permeability of the endothelial lining to other inflammatory cells such as neutrophils, causing more severe damage to the affected arteries [15].…”

The Network of Pro-Inflammatory Factors CD147, DcR3, and IL33 in the Development of Kawasaki Disease

“… 29 IFX is a vital pro-inflammatory factor significantly elevated in the blood circulation of children with KD. 30 The effectiveness of IFX in combination with IVIG treatment of nonreactive type KD is controversial. A retrospective review of 2 centers suggested that patients receiving infliximab had shorter hospitalization and fewer days of fever.…”

Enfermedad de Kawasaki: Definición, etiología, diagnóstico y manejo de la fase aguda

“…40,43 Otros estudios previos ya había dado resultados parecidos. 44,45 Glucocorticoides Un metaanálisis que incluyó 19 estudios observó una reducción significativa de AAC cuando los corticosteroides se utilizaron como tratamiento de primera línea sumado a la IGIV. Curiosamente, el análisis de subgrupos por etnicidad mostró que la reducción del riesgo fue estadísticamente significativa en la población japonesa, pero no en los no japoneses.…”