Treatment with monoclonal antibodies (mAbs) and anticytokine biologics is not effective in decreasing the frequency of coronary artery aneurysms (CAAs) in patients with Kawasaki disease (KD), but the incidence of treatment resistance may be reduced with these agents compared with conventional intravenous immunoglobulin (IVIG) therapy alone, according to findings from a systematic review and meta-analysis published in Seminars in Arthritis and Rheumatism.
Study authors sought to evaluate the effectiveness of mAbs and anticytokine biologics in the treatment of KD.
Relevant randomized controlled trials (RCTs) and observational studies (ie, cohort studies, case-control studies, case reports, and case-series) were included in the review, to summarize available evidence, both quantitatively and qualitatively. All types of mAbs and anticytokine biologic agents, along with any combination of placebo, IVIG therapy, aspirin, or corticosteroids, were considered for the treatment of KD.
The primary study outcome was the frequency of CAAs and the frequency of treatment resistance. The frequency of CAAs was reported by coronary angiogram or echocardiography within 3 months of being diagnosed with KD. Treatment resistance was persistent or recurrent fever (≥37.5 °C) between 36 hours and 7 days after completing an IVIG infusion. The secondary study outcome was the frequency of “any adverse event,” according to the study group, during the observation phase of the review and the frequency of “adverse events attributable to the administration of the medication” at any time following treatment initiation.
Among the studies searched, 183 were qualitatively evaluated. A total of 4 RCTs with 456 patients in quantitative syntheses were included in the analysis. Of the patients included in the meta-analysis, 229 were treated with tumor necrosis factor alpha (TNF-α) inhibitors (intervention group) and 227 did not receive TNF-α inhibitors (control group).
Results of the study demonstrated that the use of mAbs and anticytokine biologics did not decrease the rate of CAA (risk ratio [RR], 0.93; 95% CI, 0.65-1.32). However, the frequency of treatment resistance was reduced with the use of mAbs (RR, 0.60; 95% CI, 0.38-0.95). In addition, no statistical differences in any adverse event (RR, 0.92; 95% CI, 0.80-1.06) or adverse events attributable to the administration of the medication (RR, 1.10; 95% CI, 0.72-1.69) were reported between the intervention group and the control group.
Limitations of the analysis included small sample sizes, heterogeneity of treatment with TNF-α inhibitors, and the potential risk for bias.
Study authors concluded, “Further studies of high methodological quality are needed to establish more robust evidence for KD treatment with monoclonal antibodies and anti-cytokine biologics.”
Nomura O, Fukuda S, Ota E, Ono H, Ishiguro A, Kobayashi T. Monoclonal antibody and anti-cytokine biologics for Kawasaki disease: a systematic review and meta-analysis. Semin Arthritis Rheum. 2021;51(5):1045-1056. doi:10.1016/j.semarthrit.2021.07.020