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Evidence summaries

Tnf Blockers for Kawasaki Disease in Children

TNF-α blockers may be an effective treatment for treatment resistance and may decrease infusion reactions after treatment compared with placebo or additional treatment with intravenous immunoglobulin (IVIG) in children with Kawasaki disease. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 494 subjects. Four included studies used infliximab and one study used etanercept. One study used TNF-α blocker as an initial treatment and 4 used it as an additional treatment to initial intravenous immunoglobulin (IVIG) therapy for non-responders. Two studies compared the intervention with a second dose of IVIG, 1 study compared the intervention with an additional single dose of polyethylene glycol-treated human immunoglobulin (IVIG), and 2 studies used a placebo control.

TNF-α blockers reduced the incidence of treatment resistance, but there was no clear difference between groups in the incidence of coronary artery abnormalities (CAAs).TNF-α blocker intervention decreased infusion reactions.There was no clear difference in adverse effect 'infections', incidence of rash, or incidence of contact dermatitis (table T1). Subgroup analyses according to the timing and type of TNF-α blocker used showed no differences between groups.

TNF-α blockers intervention compared to placebo or additional treatment for children with Kawasaki disease

OutcomeRelative effect(95% CI)Risk with placebo or additional treatmentRisk with TNF-α blockers intervention (95% CI)Participants(studies)
Treatment resistanceRR 0.57(0.38 to 0.86)226 per 1000129 per 1000(86 to 194)494(5)
Incidence of coronary artery abnormalitiesRR 1.18(0.45 to 3.12)62 per 100073 per 1000(28 to 194)270 (3)
Adverse effects after treatment initiation: infusion reactionsRR 0.06(0.01 to 0.45)121 per 10007 per 1000(1 to 54)250 (3)
Adverse effects after treatment initiation: infectionsRR 0.68(0.33 to 1.37)88 per 100060 per 1000(29 to 121)227 (2)
Adverse effects after treatment initiation: rashRR 4.71(0.24 to 90.69)7 per 100031 per 1000(2 to 605)31 (1)
Adverse effects after treatment initiation: contact dermatitisRR 0.31(0.04 to 2.68)200 per 100062 per 1000(8 to 536)31 (1)

Clinical comments

Note

Date of latest search:

    References

    • Yamaji N, da Silva Lopes K, Shoda T et al. TNF-a blockers for the treatment of Kawasaki disease in children. Cochrane Database Syst Rev 2019;(8):CD012448. [PubMed]

Primary/Secondary Keywords