Shaojie Chen1, Ying Dong, Yuehui Yin, Mitchell W Krucoff. 1. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. excellentchenshaojie@126.com
Abstract
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.
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.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Judith Sánchez-Manubens; Jordi Antón; Rosa Bou; Estíbaliz Iglesias; Joan Calzada-Hernandez; Sergi Borlan; Clara Gimenez-Roca; Josefa Rivera Journal: Rheumatol Int Date: 2016-05-23 Impact factor: 2.631