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. 2021 Jan;21(1):15.
doi: 10.3892/etm.2020.9447. Epub 2020 Nov 5.

Efficacy of infliximab in the treatment of Kawasaki disease: A systematic review and meta-analysis

Zhongxing Lu  1 , Fen Wang  2 , Haitao Lv  3
Affiliations

Efficacy of infliximab in the treatment of Kawasaki disease: A systematic review and meta-analysis

Zhongxing Lu et al. Exp Ther Med. 2021 Jan.

Abstract

The present study aimed to review the relevant studies in order to determine the efficacy of infliximab (IFX) in the treatment of Kawasaki disease (KD). The relevant studies were retrieved using the PubMed, Cochrane and Embase databases. Key sources in the literature were reviewed; all articles published by July 2019 were considered for inclusion. For each study, odds ratios, mean difference and 95% confidence interval (95% CI) were assessed to evaluate study outcomes. A total of 16 studies involving 429 patients were relevant to the questions of interest of the current meta-analysis. Compared with intravenous immunoglobulin (IVIG), IFX or IFX plus IVIG significantly reduced the incidence of adverse events, including the number of patients with fever, changes in lip and oral cavity and/or cervical lymphadenopathy. The white blood cell (WBC), neutrophil and C-reactive protein (CRP) levels were also reduced in the IFX or IFX plus IVIG group compared with those in the IVIG or polyethylene glycol-treated human immunoglobulin (VGIH) groups. The platelet counts, alanine aminotransferase (ALT) levels and Z-scores were increased in the IFX or IFX plus IVIG groups compared with those in the IVIG or VGIH groups. In the single-arm studies, the incidence of coronary artery aneurysm was 0.150 (95% CI: 0.024, 0.277), the non-response rate was 0.097 (95% CI: 0.056, 0.138), and the incidence of adverse events was 0.156 (95% CI: 0.122, 0.190). IFX not only effectively reduced the incidence of fever, conjunctival injection, changes in lip and oral cavity and cervical lymphadenopathy polymorphous exanthema, but also the WBC, neutrophil, ALT and CRP levels. The platelet levels were increased in patients after the IFX therapy compared with patients in the IVIG or VGIH groups. IFX or IFX plus IVIG exhibited improved clinical efficacy in the treatment of KD compared with that of IVIG or VGIH. However, as a limited number of studies was included in the current study, the findings should be verified further.

Keywords: Kawasaki disease; infliximab; meta-analysis.

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Figures

Figure 1
Figure 1
Literature search and selection strategy.
Figure 2
Figure 2
Forest plot for adverse events in IFX or IFX plus IVIG vs. IVIG or VGIH groups. IFX, infliximab; IVIG, intravenous immunoglobulin; VGIH, polyethylene glycol-treated human immunoglobulin; CI, confidence interval; RR, relative risk.
Figure 3
Figure 3
Forest plot for coronary artery damage of IFX or IFX plus IVIG vs. IVIG or VGIH groups. IFX, infliximab; IVIG, intravenous immunoglobulin; VGIH, polyethylene glycol-treated human immunoglobulin; CI, confidence interval; RR, relative risk.
Figure 4
Figure 4
Forest plot for length of hospital stay of IFX or IFX plus IVIG vs. IVIG or VGIH groups. IFX, infliximab; IVIG, intravenous immunoglobulin; VGIH, polyethylene glycol-treated human immunoglobulin; CI, confidence interval; WMD, weighted mean difference.
Figure 5
Figure 5
Forest plot for coronary artery aneurysm of the single-arm study. CI, confidence interval; ES, effect size.
Figure 6
Figure 6
Forest plot for C-reactive protein of the single-arm study. CI, confidence interval; WMD, weighted mean difference.
Figure 7
Figure 7
Forest plot for non-response rate of the single-arm study. CI, confidence interval; ES, effect size.
Figure 8
Figure 8
Log RR funnel plot analysis of the included studies of IFX or IFX plus IVIG vs. IVIG or VGIH groups. IFX, infliximab; IVIG, intravenous immunoglobulin; VGIH, polyethylene glycol-treated human immunoglobulin.
Figure 9
Figure 9
Log RR funnel plot analysis of the included studies of the single-arm analysis.
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