[Efficacy and safety of glucocorticoids in addition to intravenous immunoglobulin in the initial treatment of Kawasaki disease: a meta-analysis of randomized trials].

OBJECTIVE

To evaluate the efficacy and safety of glucocorticoids (GC) plus intravenous immunoglobulin (IVIG) in the initial treatment of Kawasaki disease.

METHODS

Fourteen electronic databases and 3 Japanese magazines were searched. Randomized controlled trials (RCT) describing the use of GC plus IVIG in the initial treatment of Kawasaki disease in children were collected. The data of methodological quality and trial information were extracted by two independent researchers. Cochrane review methodology was used for assessing the trial quality and efficacy. Each dichotomous outcome was measured in terms of odds risk (OR) while continuous outcomes shown as weighted mean differences (WMD). And a meta-analysis was made with RevMan5.0.23.0 software.

RESULTS

A total of 416 cases in 3 trials were included. There were 209 cases in GC + IVIG group and 207 cases in IVIG group. The incidence of coronary artery lesion (CAL) was not different between GC + IVIG and IVIG groups within 1 month or 1 month post-treatment (OR: 0.74, 0.69; 95%CI: 0.23 - 2.40, 0.35 - 1.38; P = 0.62, 0.30]. The fever duration was shorter in GC + IVIG group than that in IVIG group (WMD: -0.93 d, 95%CI: -1.15 - -0.70, P = 0.00). The treatment failure rate was less in GC + IVIG group than IVIG group (9.09% vs 17.48%, OR: 0.49, 95%CI: 0.28 - 0.86, P = 0.01). No difference in adverse events was found between two groups (OR: 0.81, 95%CI: 0.22 - 3.03, P = 0.76).

CONCLUSION

There is no evidence to support that GC plus IVIG can further reduce the CAL risk of KD patients. But it may lower the treatment failure rate in KD patients.