Department of Cardiology, Children's Hospital of Soochow University, Suzhou, 215003, China.
Institute of Pediatric Research, Children's Hospital of Soochow University, China.
Eur J Pharmacol. 2021 May 15;899:173985. doi: 10.1016/j.ejphar.2021.173985. Epub 2021 Feb 27.
This meta-analysis evaluated the efficacy and safety of infliximab as initial therapy for patients with Kawasaki disease (KD) and intravenous immunoglobulin (IVIG) resistant KD. Studies of infliximab in KD, published between January 2004 and December 2019, were curated from PubMed, MEDLINE, and Cochrane Library. Data were analyzed using STATA Version 12.0. Of the 8 studies considered, 4 evaluated the effect of infliximab combined with IVIG as primary therapy in KD, and the remaining investigated the effect of infliximab in IVIG resistant patients. Infliximab was more effective than the control group, with the total summary odds ratio (OR) of 0.34 (95% confidence interval (CI): 0.19-0.62). The treatment resistance of the infliximab group was lower than the IVIG group (0.36 [95% CI: 0.14-0.92]) when infliximab was combined with IVIG as the initial treatment. However, infliximab treatment for IVIG resistant KD was more effective than the IVIG group (0.28 [95% CI: 0.12-0.66]). There was no significant increase in the incidence of coronary artery lesions. The total summary OR for the incidence of coronary artery lesions and infliximab treatment was 0.88 (95% CI: 0.48-1.62). There was no statistically significant difference in adverse events (AEs) when compared between the groups (0.71 [95% CI: 0.44-1.16]). Infliximab combined with IVIG reduced treatment resistance in KD patients vs. conventional IVIG therapy. Infliximab improved clinical course in IVIG resistant KD patients. Infliximab treatment did not reduce the incidence of coronary artery lesions and did not show any significant increase in the incidence of AEs. PROSPERO REGISTRATION NUMBER: CRD42020218554.
这项荟萃分析评估了英夫利昔单抗作为初始治疗对川崎病（KD）和静脉注射免疫球蛋白（IVIG）耐药 KD 患者的疗效和安全性。从 PubMed、MEDLINE 和 Cochrane Library 中检索了 2004 年 1 月至 2019 年 12 月期间发表的英夫利昔单抗治疗 KD 的研究。使用 STATA 版本 12.0 分析数据。在考虑的 8 项研究中，有 4 项评估了英夫利昔单抗联合 IVIG 作为 KD 主要治疗的效果，其余研究调查了英夫利昔单抗在 IVIG 耐药患者中的效果。英夫利昔单抗比对照组更有效，总汇总优势比（OR）为 0.34（95%置信区间（CI）：0.19-0.62）。当英夫利昔单抗联合 IVIG 作为初始治疗时，英夫利昔单抗组的治疗抵抗率低于 IVIG 组（0.36[95%CI：0.14-0.92]）。然而，英夫利昔单抗治疗 IVIG 耐药 KD 比 IVIG 组更有效（0.28[95%CI：0.12-0.66]）。冠状动脉病变的发生率没有显著增加。英夫利昔单抗治疗与冠状动脉病变发生率的总汇总 OR 为 0.88（95%CI：0.48-1.62）。与对照组相比，不良事件（AE）的发生率无统计学差异（0.71[95%CI：0.44-1.16]）。英夫利昔单抗联合 IVIG 降低了 KD 患者对常规 IVIG 治疗的治疗抵抗。英夫利昔单抗改善了 IVIG 耐药 KD 患者的临床病程。英夫利昔单抗治疗并未降低冠状动脉病变的发生率，也未显示 AE 发生率有任何显著增加。PROSPERO 注册号：CRD42020218554。
