PMID- 34189087
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 2224-4344 (Print)
IS  - 2224-4344 (Electronic)
IS  - 2224-4336 (Linking)
VI  - 10
IP  - 5
DP  - 2021 May
TI  - The effectiveness of infliximab for Kawasaki disease in children: systematic 
      review and meta-analysis.
PG  - 1294-1306
LID - 10.21037/tp-20-482 [doi]
AB  - BACKGROUND: Kawasaki disease (KD) is a self-limited illness that results in 
      coronary artery aneurysms (CAAs) and threatens children's health and lives. The 
      therapeutic effects of single intravenous immunoglobulin gamma (IVIG) vs. 
      infliximab (IFX) (with or without IVIG) in young children with KD remain unclear. 
      Thus, we made a meta-analysis and systematic review, including all of the studies 
      which have evaluated the effectiveness and safety of IFX and IVIG KD patients. 
      METHODS: The databases of the Cochrane Library, PubMed and Embase websites were 
      searched for articles appearing from inception until December 31, 2020. Clinical 
      studies that compared IFX either as initial therapy plus IVIG or rescue therapy 
      after IVIG (IFX group) failure compared with IVIG treatment alone (IVIG group) in 
      treating KD patients were included. RESULTS: The meta-analysis included nine 
      studies characterizing 712 patients. The treatment response was significantly 
      higher in the adjunctive IFX therapy group than in the IVIG therapy group [odds 
      ratio (OR) 2.64; 95% CI: 1.52-4.59; P=0.0005]. Subgroup analysis, the effect of 
      IFX therapy on treatment response is more effectiveness in the group of the 
      high-risk KD patients than IVIG therapy (OR 6.07; 95% CI: 2.30-16.04; P=0.0003; 
      random-effects model). Further analysis showed no difference in the improvement 
      of CAAs in short-term follow-up between the two groups. However, adding IFX 
      either as initial therapy or as additional therapy all showed an advantageous 
      effect regarding the ∆Z score of the left anterior descending (LAD) (MD =0.29; 
      95% CI: 0.27-0.31; P<0.00001) and right coronary artery (RCA) (MD =0.24; 95% CI: 
      0.22-0.26; P<0.00001). Further, IFX exhibited significant effect on the treatment 
      response compared with IVIG therapy in the Asian group (OR, 2.84; 95% CI: 
      1.51-5.36; P=0.001; random-effects model), and the beneficial effects of IFX were 
      given without increasing the risk of AEs. CONCLUSIONS: This meta-analysis 
      emphasizes the importance of IFX on the treatment response in the high-risk KD 
      patients. IFX may play a role in the Asian KD patients and prevention of 
      progressive CAA, and does not increase the risk of AEs in KD patients.
CI  - 2021 Translational Pediatrics. All rights reserved.
FAU - Li, Dan
AU  - Li D
AD  - Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, 
      Beijing, China.
AD  - Graduate School of Peking Union Medical College, Capital Institute of Pediatrics, 
      Beijing, China.
FAU - Li, Xiaohui
AU  - Li X
AD  - Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, 
      Beijing, China.
AD  - Graduate School of Peking Union Medical College, Capital Institute of Pediatrics, 
      Beijing, China.
FAU - Dou, Wenting
AU  - Dou W
AD  - Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, 
      Beijing, China.
FAU - Zheng, Yang
AU  - Zheng Y
AD  - Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, 
      Beijing, China.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Transl Pediatr
JT  - Translational pediatrics
JID - 101649179
PMC - PMC8193009
OTO - NOTNLM
OT  - Infliximab
OT  - Kawasaki disease (KD)
OT  - children
OT  - meta-analysis
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at http://dx.doi.org/10.21037/tp-20-482). The authors have no 
      conflicts of interest to declare.
EDAT- 2021/07/01 06:00
MHDA- 2021/07/01 06:01
PMCR- 2021/05/01
CRDT- 2021/06/30 06:43
PHST- 2021/06/30 06:43 [entrez]
PHST- 2021/07/01 06:00 [pubmed]
PHST- 2021/07/01 06:01 [medline]
PHST- 2021/05/01 00:00 [pmc-release]
AID - tp-10-05-1294 [pii]
AID - 10.21037/tp-20-482 [doi]
PST - ppublish
SO  - Transl Pediatr. 2021 May;10(5):1294-1306. doi: 10.21037/tp-20-482.