Methylprednisolone Pulse Therapy or Additional IVIG for Patients with IVIG-Resistant Kawasaki Disease

Wang, Zhouping; Chen, Fei-yan; Wang, Yanfei; Li, Wei; Xie, Xiaofei; Liu, Peiying; Zhang, Xu; Zhang, Li; Huang, Ping

doi:10.1155/2020/4175821

Cited by 12 publications

(4 citation statements)

References 26 publications

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“…Furthermore, one publication was removed because the full text was not available. In line with our inclusion and exclusion criteria, this work selected 10 articles published between 2003 and 2021 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Among these, seven were randomised controlled trials (RCTs) (1,15,16,(20)(21)(22), and three were non-RCTs (14,18,19), as determined based on the Cochrane Handbook.…”

Section: Results Study Selection and Descriptionmentioning

confidence: 99%

“…In line with our inclusion and exclusion criteria, this work selected 10 articles published between 2003 and 2021 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Among these, seven were randomised controlled trials (RCTs) (1,15,16,(20)(21)(22), and three were non-RCTs (14,18,19), as determined based on the Cochrane Handbook. The generation of random sequences was not utilised by Furakawa et al and Teraguchi et al since some patients were unwilling to receive IVMP and therefore received a second dose of IVIG (14,19).…”

Section: Results Study Selection and Descriptionmentioning

confidence: 99%

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Treatment of immunoglobulin-resistant kawasaki disease: a Bayesian network meta-analysis of different regimens

Pan

Fan

2023

Front. Pediatr.

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BackgroundThis study aimed to gather evidence from clinical trials on the efficacy and safety of the available treatments for intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) in children.MethodsThis work adopted the Newcastle–Ottawa scale to analyse the quality of the enrolled articles. A network meta-analysis was performed using clinical trials that compared drugs used to treat IVIG-resistant KD. Aggregate Data Drug Information System software v.1.16.5 was employed to analyse whether infliximab, second IVIG infusions, and intravenous pulse methylprednisolone (IVMP) were safe and effective.ResultsTen studies, involving 704 patients with IVIG-resistant KD, were identified and analysed. Overall, infliximab exhibited remarkable antipyretic activity compared with the second IVIG infusions (2.46, 1.00–6.94). According to the drug rank, infliximab was the best option against IVIG-resistant KD. Regarding adverse effects, the infliximab group was more prone to hepatomegaly. A second IVIG infusion was more likely to result in haemolytic anaemia. IVMP treatment was more susceptible to bradycardia, hyperglycaemia, hypertension, and hypothermia. In addition, infliximab, IVMP, and the second IVIG infusions showed no significant differences in the risk of developing a coronary artery aneurysm (CAA).ConclusionInfliximab was the best option against IVIG-resistant KD, and IVMP, infliximab, and second IVIG infusions have not significant differences of prevent CAA in patients with IVIG-resistant KD.Systematic Review RegistrationIdentifier: https://osf.io/3894y.

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Section: Results Study Selection and Descriptionmentioning

confidence: 99%

Section: Results Study Selection and Descriptionmentioning

confidence: 99%

Treatment of immunoglobulin-resistant kawasaki disease: a Bayesian network meta-analysis of different regimens

Pan

Fan

2023

Front. Pediatr.

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“…While about one-quarter of the prescriptions were based on evidence, the remaining three quarters may potentially include inappropriate medication use, with a total cost of about ¥81 000, corresponding to about US$11 200, per day in Gansu Province, a province of China with about 25 million inhabitants. 43 The development of drugs for children, especially drugs for neonates and topical medicines, should be promoted. The management of off-label drug use in paediatrics in China needs improvement.…”

Section: Discussionmentioning

confidence: 99%

Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study

Meng,

Ge,

Lei

et al. 2024

BMJ Open

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ObjectiveTo examine the current prevalence and cost of paediatric off-label drug prescriptions in Gansu, China, and the potential influencing factors.DesignThe prevalence of off-label prescriptions in paediatrics was evaluated according to the National Medical Products Administration drug instructions in the China Pharmaceutical Reference (China Pharmaceutical Reference, MCDEX) database. The evidence of the prescription was determined by existing clinical practice guidelines and the Thomson Grade in the Micromedex 2021 compendium. We used logistic regression to investigate the characteristics that influence paediatric off-label drug use after single-factor regression analysis.SettingA multicentre cross-sectional study of outpatient paediatric prescriptions in 196 secondary and tertiary hospitals in Gansu Province, China, in March and September 2020.ResultsWe retrieved 104 029 paediatric prescriptions, of which 39 480 (38.0%) contained off-label use. The most common diseases treated by off-label drugs were respiratory system diseases (n=15 831, 40.1%). A quarter of off-label prescriptions had adequate evidence basis (n=10 130, 25.6%). Unapproved indications were the most common type of off-label drug use (n=25 891, 65.6%). A total of 1177 different drugs were prescribed off-label, with multienzyme tablets being the most common drug (n=1790, 3.5%). The total cost of the prescribed off-label drugs was ¥106 116/day. Off-label prescriptions were less frequent in tertiary than in secondary hospitals. Topical preparations were more commonly prescribed off-label than other types of drugs. Senior-level clinicians prescribed drugs off-label more often than intermediate and junior clinicians.ConclusionOff-label drug use is widespread in paediatric practice in China. Three-quarters of the prescriptions may potentially include inappropriate medication use, resulting in a daily economic burden of about ¥81 000 in 2020 in Gansu Province with 25 million inhabitants. The management of off-label drug use in paediatrics in China needs improvement.

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“…Estudios no encontraron diferencias significativas, 47 y un estudio aleatorizado, aunque que la metilprednisolona estaba asociada a reducción de la fiebre y reactantes de fase aguda, mostró mayor incidencia de fallo al tratamiento y aparición de AAC en el seguimiento a largo plazo. 48…”

Section: Infliximabunclassified

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

Herrera,

Tomalá-Haz

2022

RevReumDia

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La enfermedad de Kawasaki es una vasculitis de vasos de pequeño y mediano calibre, fue descrita por primera vez en el año 1967. Afecta principalmente a niños menores de 5 años y representa la principal causa de cardiopatía adquirida en niños. A raíz de su descripción al no haber ninguna prueba diagnóstica patognomónica, se idearon criterios diagnósticos tanto por la Sociedad Japonesa como por la Academia Americana del Corazón. Estos criterios han sido modificados en el tiempo, y describen a la enfermedad como Kawasaki completo, incompleto y atípica, basándose en las características clínicas (fiebre, exantema polimorfo, conjuntivitis no purulenta, labios eritematosos y/o lengua aframbuesada, edema de manos y pies o descamación palmo-plantar, adenopatía cervical de más de 1,5 cm de preferencia unilateral) y datos de laboratorio (leucocitosis, anemia, trombocitosis, PCR alta, transaminasas altas, hipoalbuminemia, piuria estéril). La etiopatogenia es desconocida, aunque se ha encontrado ciertos genes asociados, y se sabe que la respuesta inmune involucrada es la innata y la adaptativa. El ecocardiograma inicial es importante pero no debe retrasar el tratamiento en caso de ya contar con el diagnóstico. El tratamiento oportuno con inmunoglobulina G(IGIV) endovenosa y aspirina, permite disminuir la incidencia de anormalidades coronarias de un 25% a un 5%. Actualmente, la dosis de aspirina está siendo motivo de revisión. El 15% de los pacientes son refractarios a la IGIV, en ellos se han usado una segunda dosis de IGIV, corticoterapia, infliximab, ciclosporina. La PCR y la eritrosedimentación alta son factores predictores de anormalidad de las arterias coronarias.

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Methylprednisolone Pulse Therapy or Additional IVIG for Patients with IVIG-Resistant Kawasaki Disease

Cited by 12 publications

References 26 publications

Treatment of immunoglobulin-resistant kawasaki disease: a Bayesian network meta-analysis of different regimens

Treatment of immunoglobulin-resistant kawasaki disease: a Bayesian network meta-analysis of different regimens

Paediatric off-label use of drugs in Gansu, China: a multicentre cross-sectional study

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

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