title: Effect and Safety of TNF Inhibitors in Immunoglobulin-Resistant Kawasaki Disease: a Meta-analysis.
abstract: Previous studies showed that tumor necrosis factor (TNF) inhibitors might decrease the rate of coronary artery abnormalities in pediatrics with intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD). Therefore, we aimed to evaluate the effect and safety of TNF inhibitors in IVIG-resistant KD. We undertook a meta-analysis of clinical trials identified in systematic searches of PubMed, EMBASE, Cochrane Database, and Google scholar through May 2016. Five studies were included. Overall, rate of coronary artery aneurysm was comparable between groups (relative risk (RR), 1.05; 95 % confidence interval (95 % CI), 0.60 to 1.81; P = 0.87). No significant differences were recorded between groups in coronary artery Z scores (standardized mean difference (SMD), 0.27; 95 % CI, -0.30 to 0.85; P = 0.35). Meanwhile, TNF inhibitors were not associated with a significant decreased risk of treatment resistance compared with IVIG treatment (RR, 0.65; 95 % CI, 0.37 to 0.15; P = 0.14). However, days of fever was significantly reduced in the TNF inhibitor group (SMD, -0.66; 95 % CI, -0.90 to -0.41; P < 0.001). Additionally, risk of serious adverse events was similar between groups. Therefore, TNF inhibitors could shorten the duration of fever in IVIG-resistant KD. However, TNF inhibitors appear to have no cardioprotective effect in patients with IVIG-resistant KD.
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Xue
authors.affiliation: Department of Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Yanzhou University Medical School, Huaian, Jiangsu, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wu
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Gui-Lian
authors.initials: GL
authors.lastname: Du
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Kang-Yan
authors.initials: KY
authors.lastname: Yuan
authors.affiliation: Department of Neonatology, BAYI Children's Hospital, No. 2, Chao Inner north Street, DongCheng District, Beijing, China. fengzhichun2015@126.com.
authors.forename: Zhi-Chun
authors.initials: ZC
authors.lastname: Feng
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Pan
authors.affiliation: Department of Neonatology, SongGang Hospital, BaoAn District, Shenzhen, Guangdong, China.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Hu
mesh_terms: D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003330:Coronary Vessel Anomalies / Q000276:immunology / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D005334:Fever; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007167:Immunotherapy / Q000379:methods*; D007223:Infant; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology / Q000378:metabolism*
chemical_list: D016756:Immunoglobulins, Intravenous; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Coronary artery aneurysm; Kawasaki disease; Meta-analysis; Prognosis; Tumor necrosis factor inhibitor