Efficacy of glucocorticoids combined with immunoglobulin in initial treatment of Kawasaki disease: a Meta analysis

Abstract:

Objective To systematically investigate the efficacy and safety of glucocorticoids (GCs) combined with intravenous injection of immunoglobulin (IVIG) in the initial treatment of Kawasaki disease (KD). Methods MEDLINE Database, PubMed Database, CNKI, Wanfang Data, and VIP Database were searched to collect prospective or retrospective controlled studies on the combination of GCs and IVIG as the initial treatment of KD, which were published up to March 2016. Two investigators independently screened the literature, extracted data, and assessed the quality of the articles included. Then, a Meta analysis was performed using RevMan 5.2 software. Results A total of 11 articles in English were included, with 7 prospective studies and 4 retrospective studies. The results of the Meta analysis showed that compared with the group using IVIG alone, the combination group had a significantly lower incidence rate of coronary artery lesion (CAL) (OR = 0.44, 95%CI 0.23-0.86, P = 0.02) and a significantly shorter duration of fever (MD = -1.66, 95%CI -2.32 to -1.01, P < 0.00001). The combination group had a significantly lower rate of no response to initial treatment than the IVIG alone group (OR = 0.37, 95%CI 0.27-0.51, P < 0.00001). The recurrence rate of KD and the incidence rate of adverse events showed no significant differences between the two groups. Conclusions GCs combined with IVIG as the initial treatment for KD can reduce the incidence rate of CAL and the rate of no response to initial treatment and shorten the duration of fever, and does not increase the recurrence rate of KD and the incidence rate of adverse events.