Intravenous immunoglobulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis
- 1Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Key laboratory of Pediatrics in Chongqing and Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
- 3Duke University Medical Center, Duke Clinical Research Institute, 508 Fulton Street, Durham, North Carolina, USA
- Correspondence to Dr Shaojie Chen, or Yuehui Yin, Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400010, China;
Contributors All authors contributed to this paper, and have read and approved this article. No part of this paper has been published or considered for publication elsewhere. Drs Chen S and Dong Y were responsible for literature search, data collection, statistical analysis and manuscript drafting. Profs Yin Y and Krucoff MW directed the study performance and guided the manuscript writing.
- Received 27 March 2012
- Accepted 8 May 2012
- Published Online First 6 August 2012
Objective To summarise clinical trials that compared the incidence of coronary abnormality between intravenous immune globulin (IVIG) plus corticosteroid therapy and IVIG therapy alone, and to determine the overall efficacy and safety of IVIG plus corticosteroid therapy for the initial treatment of Kawasaki disease.
Background Although use of IVIG as initial therapy has been established in Kawasaki disease, the role of corticosteroids therapy is controversial.
Methods Medline, The Cochrane Library, The Clinical Trials, and Embase Database were searched for published clinical studies up to 31 March 2012. Studies that compare the efficacy of IVIG plus corticosteroid with that of IVIG in treating Kawasaki disease were included. The coronary outcome and adverse events were analysed by meta-analysis.
Results 9 clinical studies with a total of 1011 patients were identified. Meta-analysis of the 9 studies showed that IVIG plus corticosteroid therapy significantly reduced the risk of coronary abnormality (OR: 0.3; 95% CI 0.20 to 0.46). Similar results were observed in subgroup analyses of randomised controlled studies (OR: 0.3; 95% CI 0.18 to 0.5), studies focused on patients with a high risk of IVIG resistance (OR: 0.2; 95% CI 0.1 to 0.36) and studies with blinded-endpoint manner (OR: 0.32; 95% CI 0.19 to 0.55). There was no significant difference in the incidence of severe adverse events between the IVIG plus corticosteroid group, and the IVIG group (OR: 1.24; 95% CI 0.33 to 4.67).
Conclusions Combination of corticosteroid with the conventional regimen of IVIG as an initial treatment strategy could reduce the risk of coronary abnormality.
- Kawasaki disease
- corticosteroid therapy
- coronary artery
- heart failure
- cardiac resynchronisation therapy
- coronary artery disease
- atrial fibrillation
- heart failure treatment
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.