Higher efficacy of infliximab than immunoglobulin on Kawasaki disease, a meta-analysis
Higher efficacy of infliximab than immunoglobulin on Kawasaki disease, a meta-analysis
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一项荟萃分析显示英夫利昔单抗比免疫球蛋白治疗川崎病的疗效更高
DOI：
10.1016/j.ejphar.2021.173985
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发表时间：
2021-03-10
影响因子：
5
通讯作者：
Lv, Haitao
中科院分区：
文献类型：
--
作者：
Li, Xuan;Tang, Yunjia;Lv, Haitao
本荟萃分析评价了英夫利西单抗作为川崎（KD）和静脉注射免疫球蛋白（IVIG）耐药KD患者初始治疗的有效性和安全性。2004年1月至2019年12月期间发表的关于KD的英夫利西单抗研究来自PubMed、MEDLINE和科克伦图书馆。使用STATA版本12.0分析数据。在所考虑的8项研究中，4项评价了英夫利西单抗联合IVIG作为KD主要治疗的效果，其余研究了英夫利西单抗在IVIG耐药患者中的效果。英夫利西单抗比对照组更有效，总汇总比值比（OR）为0.34（95%置信区间（CI）：0.19-0.62）。当英夫利西单抗与IVIG联合作为初始治疗时，英夫利西单抗组的治疗抵抗低于IVIG组（0.36 [95%CI：0.14-0.92]）。然而，英夫利西单抗治疗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。冠状动脉病变发生率和英夫利西单抗治疗的总汇总OR为0.88（95% CI：0.48-1.62）。两组之间的不良事件（AE）无统计学显著差异（0.71 [95% CI：0.44-1.16]）。与常规IVIG治疗相比，英夫利西单抗联合IVIG降低了KD患者的治疗抵抗。英夫利西单抗改善IVIG耐药KD患者的临床病程。英夫利西单抗治疗未降低冠状动脉病变的发生率，也未显示AE的发生率显著增加。普洛斯彼罗注册号：CRD 42020218554。
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.