Four studies stated that randomisation was arranged centrally, but did not provide details, so were assessed as unclear for random sequence generation and low for allocation concealment (Ogawa 1987;Ogino 1987;Onouchi 1992;Yabiku 1989)

Four studies stated that randomisation was arranged centrally, but did not provide details, so were assessed as unclear for random sequence generation and low for allocation concealment (Ogawa 1987;Ogino 1987;Onouchi 1992;Yabiku 1989). ClinicalTrials.gov tests registers to 26 April 2022. == Selection criteria == We included randomised controlled trials (RCTs) investigating the use of IVIG for the treatment of KD. We included studies including treatment for initial or refractory KD, or both. == Data collection and analysis == We used standard Cochrane methods. Our primary results were incidence of CAAs and incidence of any adverse effects after treatment. Our secondary outcomes were acute coronary syndromes, duration of fever, need for additional treatment, length of hospital stay, and mortality. We used GRADE to assess the certainty of the evidence for each end result. == Main results == We recognized 31 RCTs including a total of 4609 participants with KD. Studies compared IVIG with ASA, another dose or routine of IVIG, prednisolone, or infliximab. The majority of studies reported on main treatment, so those results are reported below. A limited quantity of studies investigated secondary or tertiary treatment in IVIGresistant individuals. Doses and regimens of IVIG infusion assorted between studies, and all studies experienced some issues related to risk of bias. Main treatment with IVIG compared to ASA for people with KD Compared to ASA treatment, IVIG probably reduces the incidence of CAAs in people with KD up to 30 days (odds percentage (OR) 0.60, 95% confidence interval (CI) 0.41 to 0.87; 11 studies, 1437 participants; moderatecertainty evidence). The individual studies reported a range of adverse effects, but there was little to no difference in numbers of adverse effects between treatment organizations (OR 0.57, 95% CI 0.17 to 1 1.89; 10 studies, 1376 participants; very lowcertainty evidence). There was limited evidence for the incidence of acute coronary BM-131246 syndromes, so we are uncertain of any effects. Duration of fever BM-131246 days from treatment onset was probably shorter in the IVIG group (mean difference (MD) 4.00 days, 95% CI 5.06 to 2.93; 3 studies, 307 participants; moderatecertainty evidence). There was little or no difference between organizations in need for additional treatment (OR 0.27, 95% CI 0.05 to 1 1.57; 3 studies, 272 participants; lowcertainty evidence). No study reported length of hospital stay, and no Cspg2 deaths were reported in either group. Main treatment with IVIG compared to different infusion regimens of IVIG for people with KD Higherdose regimens of IVIG probably reduce the incidence of CAAs compared to medium or lowerdose regimens of IVIG up to 30 days (OR 0.60, 95% CI 0.40 to 0.89; 8 studies, 1824 participants; moderatecertainty evidence). There was little to no difference in BM-131246 the number of adverse effects between organizations (OR 1.11, 95% CI 0.52 to 2.37; 6 studies, 1659 participants; lowcertainty evidence). No study reported on acute coronary syndromes. Higherdose IVIG may reduce the duration of fever compared to medium or lowerdose regimens (MD 0.71 days, 95% CI 1.36 to 0.06; 4 studies, 992 participants; lowcertainty evidence). Higherdose regimens may reduce the need for additional treatment (OR 0.29, 95% CI 0.10 to 0.88; 4 studies, 1125 participants; lowcertainty evidence). We did not detect a definite difference in length of hospital stay between infusion regimens (MD 0.24, 95% CI 0.78 to 0.30; 3 studies, 752 participants; lowcertainty evidence). One study reported mortality, and there was little to no difference recognized between regimens (moderatecertainty evidence). Main treatment with IVIG compared to prednisolone for people with KD The evidence comparing IVIG with prednisolone on incidence of CAA is very uncertain (OR 0.60, 95% CI 0.24 to 1 1.48; 2 studies, 140 participants; very lowcertainty evidence), and there was little to no difference between organizations BM-131246 in adverse effects (OR 4.18, 95% CI 0.19 to 89.48; 1 study; 90 participants; lowcertainty evidence). We are very uncertain of the impact on duration of fever, as two studies reported this end result in a different way and showed conflicting results. One study reported on acute coronary syndromes and mortality, finding little or no difference between organizations (lowcertainty evidence). No study reported the need for more treatment or length of hospital stay. == Authors’ conclusions == The included RCTs investigated a variety of comparisons, and the small quantity of events observed during the study periods limited detection of effects. The.