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Comment on a meta-analysis of re-treatment for intravenous immunoglobulin-resistant Kawasaki disease

Published online by Cambridge University Press:  16 March 2016

Lei Zhang ,
Xiu-ping Chen  and
Yuan-han Qin
Lei Zhang
Affiliation:
Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, Nanning, China Department of Pediatric, Affiliated Hospital of Hebei University, Baoding, China
Xiu-ping Chen
Affiliation:
Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, Nanning, China
Yuan-han Qin*
Affiliation:
Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, Nanning, China
*
Correspondence to: Y.-H. Qin, Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, Nanning 530021, China. Tel:+86 0771 535 6633; Fax:+86 0771 535 0031; E-mail: qinyuanhan603@163.com
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Type
Letter to the Editor
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 1036
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Copyright
© Cambridge University Press 2016 

Dear Editor,

We read with great interest the meta-analysis by Yang et alReference Yang, Liu, Huang, Chen, Du and Jin 1 comparing re-treatment efficacy of glucocorticosteroids or intravenous immunoglobulin for patients with immunoglobulin-resistant Kawasaki disease. The results from this analysis of four cohort studies involving 52 patients treated with second intravenous immunoglobulin and 75 patients treated with glucocorticosteroid suggested that glucocorticosteroids are more effective in controlling body temperature compared with intravenous immunoglobulin and that there was no difference in the prevention of coronary artery lesions between groups.

The aim of their study was to determine the optimal drug therapy for intravenous immunoglobulin-resistant Kawasaki disease; however, they only evaluated the effects of a second intravenous immunoglobulin compared with glucocorticoids as a clinical treatment for intravenous immunoglobulin-resistant Kawasaki disease. There are only two agents involved in this meta-analysis, and some other agents may also have the efficacy to improve the process of immunoglobulin-resistant Kawasaki disease, such as infliximab.

For reasons that are unclear, among the four selected manuscripts, two belong to the same author,Reference Miura, Ohki and Yoshiba 2 , Reference Miura, Kohno, Ohki, Yoshiba, Sugaya and Satoh 3 and each date is derived from the same trial of different stages. Such problems weaken the validity of the meta-analysis by Yang et al.

Nevertheless, we extol Yang et al on their effort, and studies such as this meta-analysis are necessary to gain optimal re-treatment methods, which remain controversial for immunoglobulin-resistant patients. Such studies should be conducted in a way that includes broad agents and must avoid errors cautiously.

Thank you very much!

Best regards to you!

Yuan-han Qin

References

1. Yang, X, Liu, G, Huang, Y, Chen, S, Du, J, Jin, H. A meta-analysis of re-treatment for intravenous immunoglobulin-resistant Kawasaki disease. Cardiol Young 2015; 25: 1182–1190.Google Scholar
2. Miura, M, Ohki, H, Yoshiba, S, et al. Adverse effects of methylprednisolone pulse therapy in refractory Kawasaki disease. Arch Dis Child 2005; 90: 1096–1097.Google Scholar
3. Miura, M, Kohno, K, Ohki, H, Yoshiba, S, Sugaya, A, Satoh, M. Effects of methylprednisolone pulse on cytokine levels in Kawasaki disease patients unresponsive to intravenous immunoglobulin. Eur J Pediatr 2008; 167: 1119–1123.Google Scholar