Monoclonal antibody therapy for Kawasaki disease: A protocol for systematic reviews and meta-analysis

Background: Kawasaki disease (KD) is a form of self-limiting vasculitis that causes coronary artery abnormality in children. Based on reports of elevated plasma level of cytokines such as tumor necrosis factor-a in KD patients, clinical trials of monoclonal antibodies that block cytokine cascades have been conducted. However, the studies have revealed contradictory results. The objective of this study is to examine the effectiveness of treatment with monoclonal antibodies for KD patients. Methods: Relevant randomized controlled trials (RCTs), cluster RCTs, quasi-RCTs, cross-over trials, and any observational studies (e.g., cohort studies, case-control studies, case series, and case reports) will be included to summarize available evidence both qualitatively and quantitatively. Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ICUSHI will be searched. We will assess coronary artery and treatment outcomes of the interventions. Two authors will independently screen studies for inclusion and consulting with a third author where necessary to resolve discrepancies. The risk of bias of included studies will be assessed using the Cochrane Collaboration risk of bias tool and quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis of the included studies will be conducted using fixed effects or random effects models depending on the degree of between-study heterogeneity. Results will be presented using risk ratios with 95 % confidence interval (CI) for dichotomous outcomes and standardized mean differences with 95 % CI for continuous outcomes. Discussion: This systematic review and meta-analysis protocol does not require ethical approval. We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. © 2016 Nomura et al.