SynthesisBMC pediatrics2019
Indirect-comparison meta-analysis of treatment options for patients with refractory Kawasaki disease.
Synthesis in BMC pediatrics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease.Arthritis & rheumatology (Hoboken, N.J.) · 2022Guideline
- 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease.Arthritis care & research · 2022Guideline
- Pooled it
- Comparison of second-line therapy in IVIg-refractory Kawasaki disease: a systematic review.Pediatric rheumatology online journal · 2019Pooled it
- The gut microbiota and kawasaki disease: exploring the role of microbial dysbiosis and metabolites in pathogenesis and therapeutics.European journal of pediatrics · 2026Review
- The use of glucocorticoids in immunoglobulin-resistant Kawasaki disease.Scientific reports · 2026Article
- Clinical Practice Variation Among Pediatric Rheumatologists Treating Kawasaki Disease: Results of a North American Survey.Children (Basel, Switzerland) · 2025Article
- Interplay of gut microbiota in Kawasaki disease: role of gut microbiota and potential treatment strategies.Future microbiology · 2025Review
- Coronary Arteries Lesions in Kawasaki Disease: Risk Factors in an Italian Cohort.Biomedicines · 2024Article
- Prediction of coronary artery lesions in children with Kawasaki syndrome based on machine learning.BMC pediatrics · 2024Article
- Editorial: Multisystem inflammatory syndrome in children.Frontiers in pediatrics · 2024Article
- Evaluation of Formosa score and diagnostic sensitivity and specificity of four Asian risk scores for predicting intravenous immunoglobulin resistance in Kawasaki disease: a bivariate meta-analysis.Frontiers in cardiovascular medicine · 2023Review
- Treatment of immunoglobulin-resistant kawasaki disease: a Bayesian network meta-analysis of different regimens.Frontiers in pediatrics · 2023Review
- Prediction of repeated intravenous immunoglobulin resistance in children with Kawasaki disease.BMC pediatrics · 2021Article
- Treatment of Kawasaki Disease: A Network Meta-Analysis of Four Dosage Regimens of Aspirin Combined With Recommended Intravenous Immunoglobulin.Frontiers in pharmacology · 2021Article
- Low-Dose Prednisone Treatment for IVIG-Resistant Kawasaki Disease with Severe Arthritis and Joint Effusion in Two 3-Year-Old Children.Case reports in pediatrics · 2021Article
- A Cost Comparison of Infliximab Versus Intravenous Immunoglobulin for Refractory Kawasaki Disease Treatment.Hospital pediatrics · 2021Article
- Review
- Antibodies and Immunity During Kawasaki Disease.Frontiers in cardiovascular medicine · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is limited information available regarding the clinical management of intravenous immunoglobulin-resistant Kawasaki disease (KD). We aimed to evaluate the optimal treatment options for patients with refractory KD by presenting an indirect-comparison meta-analysis.
methodsPubMed, EMBASE, Web of Science, and the Cochrane Database were searched on August 31, 2018. Unpublished studies were also searched in ProQuest Dissertations & Theses and through manual retrieval strategies. Randomized concurrent controlled trials (RCTs), high-quality non-randomized concurrent controlled trials (non-RCTs), and retrospective studies associated with AEs were included. The quality of all eligible studies was assessed using Cochrane collaboration's tool and non-randomized study guidelines. Risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes were estimated in our analysis. GRADE profiler 3.6.1 was used to assess the evidence profile.
resultsTwelve studies involving 372 immunoglobulin-resistant KD patients were identified and analyzed. Neither infliximab nor intravenous pulse methylprednisolone (IVMP) was significantly more effective than second IVIG infusion with respect to lowering coronary artery lesions (CALs) (infliximab, 0.85, 0.43-1.69; IVMP, 0.99, 0.52-1.88) and treatment resistance (infliximab, 0.43, 0.21-0.89; IVMP, 1.16, 0.33-4.13). No significant differences were found between infliximab and IVMP in the incidence rate of CALs (0.70, 0.27-1.81), the treatment resistance (0.37, 0.09-1.60), the rates of coronary artery aneurysm (4.13, 0.38-45.22) and the coronary artery dilatation (0.45, 0.10-1.99). Furthermore, compared with second IVIG infusion, both infliximab and IVMP showed significant effectiveness in antipyretic effects (infliximab, 1.52, 1.16-1.99; IVMP, 1.29, 0.77-2.15). However, Infliximab was noninferior to IVMP on antipyretic effects (1.18, 0.66-2.15). IVMP treatment showed significant association with fewer AEs than second IVIG infusion (0.49, 0.26-0.94) and infliximab (2.34, 1.07-5.09). No significant differences were noted between infliximab treatment and second IVIG infusion (1.06, 0.69-1.63).
conclusionsInfliximab, IVMP, and second IVIG infusion showed no significant differences in the cardioprotective effect or the rate of treatment resistance. Infliximab and IVMP treatment were more effective than second IVIG infusion regarding antipyretic effects. IVMP treatment may have an advantage due to its lower total rate of AEs associated with drug infusion.
trial registrationThe study has been registered on PROSPERO ( CRD42016039693 ).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.