Catherine Uy CanoCardinal Santos Medical Center, Philippines
Title: A systematic review and meta-analysis on the safety and efficacy of second dose immunoglobulin versus high dose pulse methylprednisolone in refractory Kawasaki disease
Background: There is limited information available regarding the management of IVIG-refractory Kawasaki Disease (KD).
Objectives: This study aimed to evaluate the safety and efficacy of a second intravenous immunoglobulin (IVIG) infusion versus intravenous methylprednisolone (IVMP) in patients with IVIG-refractory KD.
Methodology: Cochrane Library, PubMed, Medline, Elsevier (Science Direct), Springer Link and BMJ databases were searched from May 1, 2020 to December 31, 2020. We included randomized controlled trials (RCTs) and high-quality prospective and retrospective studies, with population restricted to children 0 months to 18 years, with KD refractory to initial IVIG (2g/kg), (who remained febrile for 24-48 hours after completion of initial IVIG,) and who received second-line monotherapy with either a second dose IVIG or IVMP. We conducted a meta-analysis using Review Manager [RevMan] 5.4.1 software.
Results: A total of six studies in (n=188 patients) were analyzed. The incidence of coronary artery lesions was comparable between a second dose of IVIG and IVMP (RR 0.82, 0.34-1.96, P= 0.66), in patients with IVIG-refractory KD. The rate of fever resolution to a second IVIG, compared to IVMP was not significantly different between groups (RR 0.97, 0.84-1.13, P = 0.72). There was a significantly higher incidence of adverse events in the IVMP group (RR 0.42, 0.26-0.57, P=0.0002), but these were all transient and resolved without further treatment.
Conclusions: There is no significant difference in the incidence of coronary artery lesions and rate of fever resolution post-retreatment with a second dose of IVIG versus IVMP in IVIG-refractory KD. More adverse events were reported in the IVMP group.
Catherine Uy Cano has completed her MD at the age of 25 years from University of Santo Tomas, Philippines, and her Master of Health Management at the age of 28 years from Queensland University of Technology, Brisbane Australia. She is currently a third year Pediatric Resident in Cardinal Santos Medical Center, Philippines.