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A Meta-analysis of medication for intravenous immunoglobulin resistant Kawasaki disease

Objective This study was aimed at evaluating present randomized controlled trials (RCT) regarding the drug therapy for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD). Methods According to inclusion and exclusion criteria,articles were selected from medical electronic databases. RCT were then assessed based on the Juni assessment,and meta-analysis was completed by the Review Manager 4.2 software. Indications to evaluate effects were the change of body temperature and change of coronary artery situation detected by ultrasound-cardiogram. The results were stated as relative risk (RR) or odd ratio (OR),with a 95% confidence interval (CI) and a P 0.05 significant level. Results In total,three RCT were selected. Funel plot analysis showed possible publication bias. Meta-analysis of the three RCT,including all 59 patients in the 2nd intravenous immunoglobulin treatment group and 66 patients in the glucocorticosteroid treatment control group,indicated that after their first doses of IVIG treatment,the temperatures of IVIG resistant KD patients who received 2nd IVIG treatment could be more effectively improved than those who received glucocorticosteroid treatment (RR = 1.29,95% CI:1.10～1.52,P = 0.002); but there were no differences on the incidence of coronary artery aneurysm between two groups (OR = 0.91,95% CI:0.33～2.49,P = 0.85). Conclusion The Meta-analysis of currently published RCT demonstrates that the 2nd IVIG can more effectively improve the temperature than glucocorticosteroid in IVIG resistant KD patients; but there were no differences on the incidence of coronary artery aneuysm between two groups.