WITHDRAWN: Infliximab versus intravenous pulse methylprednisolone treatment for immunoglobulin-resistant kawasaki disease: a systematic review and adjusted indirect comparison metaanalysis

// Han Chan 1, 2, * , Yuhao Wang 1, * , Junli Yan 1, 2, * , Gaofu Zhang 1, 2 , Mo Wang 1, 2 , Haiping Yang 1, 2 and Qiu Li 1, 2 1 Department of Nephrology, Children’s Hospital of Chongqing Medical University, Chongqing, China 2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China * These authors contributed equally to this work Correspondence to: Haiping Yang, email: oyhp0708@163.com Qiu Li, email: liqiu809@126.com Keywords: infliximab; methylprednisolone; intravenous immunoglobulin; mucocutaneous lymph node syndrome Received: September 01, 2017     Accepted: November 16, 2017     Published: January 02, 2018 ABSTRACT Background: Infliximab, intravenous pulse methylprednisolone (IVMP), and intravenous immunoglobulin (IVIG) retreatment are commonly used for the management of immunoglobulin-resistant Kawasaki disease (KD). Objective: To evaluate the safety and efficacy of these three therapies in pediatric patients with IVIG-resistant KD by performing an adjusted indirect comparison meta-analysis. Materials and Methods: PubMed, Embase, Web of Science, Clinicaltrials.gov , and Cochrane databases were searched on August 10, 2017. The main outcomes analyzed were coronary artery lesions (CALs) (e.g., coronary artery aneurysm or coronary artery dilatation), treatment resistance, adverse events (AEs) associated with drug infusion and antipyretic effects. Results: Eleven studies involving 341 immunoglobulin-resistant KD patients were identified and analyzed. The total incidence rate of CALs for infliximab versus IVMP was 0.78 (0.29–2.05), and the rates of coronary artery aneurysm (4.13, 0.38–45.22) and coronary artery dilatation (0.45, 0.10–1.99) did not differ significantly between groups. The rate of treatment resistance for infliximab versus IVMP was 0.22 (0.03–1.47), and antipyretic effects for infliximab versus IVMP was 1.14 (0.63–2.05). The total rate of AEs for infliximab versus IVMP was 2.54 (1.003–6.411). Conclusions: No significant differences were observed among the 3 conventional therapies in the cardioprotective effect or the rate of treatment resistance. Infliximab and IVMP were more effective than additional IVIG due to antipyretic effects. IVMP treatment may have an advantage due to its lower total rate of AEs associated with drug infusion.