A systematic review and meta-analysis on the safety and efficacy of Second Dose Immunoglobulin versus High Dose Pulse Methylprednisolone in Refractory Kawasaki Disease
https://doi.org/10.56964/pidspj20222301005
- Author:
Catherine Uy Cano
1
;
Teldy Ley-Chua
1
;
Robert Dennis Garcia
1
,
2
Author Information
1. Department of Pediatrics, Cardinal Santos Medical Center
2. Department of Pediatrics, Makati Medical Center
- Publication Type:Journal Article
- Keywords:
Refractory Kawasaki Disease;
Second IVIG Infusion
- MeSH:
Mucocutaneous Lymph Node Syndrome;
Immunosuppressive Agents;
Immunoglobulins, Intravenous;
Methylprednisolone
- From:
Pediatric Infectious Disease Society of the Philippines Journal
2022;23(1):15-26
- CountryPhilippines
- Language:English
-
Abstract:
Background:There is limited information available regarding the management of IVIG-refractory Kawasaki Disease (KD).
Objective:This study aimed to evaluate the safety and efficacy of a second intravenous immunoglobulin (IVIG) infusion versus intravenous methylprednisolone (IVMP) in patients with IVIG-refractory KD.
Methodology:Cochrane Library, PubMed, Medline, Elsevier (Science Direct), Springer Link and BMJ databases were searched from May 1, 2020 to December 31, 2020. We included randomized controlled trials (RCTs) and high-quality prospective and retrospective studies, with population restricted to children 0 months to 18 years, with KD refractory to initial IVIG at 2g/kg, who remained febrile for 24-48 hours after completion of initial IVIG, and who received second-line monotherapy with either a second dose IVIG or IVMP. We conducted a meta-analysis using Review Manager [RevMan] 5.4.1 software.
Results:A total of six studies (n=188 patients) were analyzed. The incidence of coronary artery lesions was comparable between a second dose of IVIG and IVMP (RR 0.82, 0.34-1.96, P=0.66) in patients with IVIG-refractory KD. The rate of fever resolution to a second IVIG, compared to IVMP, was not significantly different between groups (RR 0.97, 0.84-1.13, P=0.72). There was a significantly higher incidence of adverse events in the IVMP group (RR 0.42, 0.26-0.57, P=0.0002), but these were all transient and resolved without further treatment.
Conclusion:There is no significant difference in the incidence of coronary artery lesions and rate of fever resolution post-retreatment with a second dose of IVIG versus IVMP in IVIG-refractory KD. More adverse events were reported in the IVMP group.
- Full text:005_PIDSP-vol-23-no-1_CANO_IVIG (1).pdf
