The Efficacy of Retreatment Modalities for IVIG-Resistant Kawasaki Disease: A Bayesian Network Meta-Analysis

Background This study aimed to evaluate optimal retreatment strategies for intravenous immunoglobulin (IVIG)-resistant cases. Methods A Bayesian network meta-analysis (NMA) of 19 studies (n = 5,060) from multiple databases (inception to September 2023) was conducted to compare the efficacy of miscellaneous retreatment strategies. Outcomes were quantified using odds ratios (ORs) with 95% credible intervals (CIs) and surface under cumulative ranking (SUCRA) probabilities. Results The NMA demonstrated that both infliximab (IFX) monotherapy (OR 0.33, 95% CI 0.20–0.54) and IVIG combined with corticosteroids (OR 0.21, 95% CI 0.09–0.50) exhibited statistically significant differences in reducing the rate of treatment failure compared to IVIG monotherapy. None of the retreatment strategies demonstrated statistically significant differences in reducing the incidence of CALs. The SUCRA rankings for CAL prevention were: IFX monotherapy (0.784), plasma exchange (0.668), IVIG combined with corticosteroids (0.623), IVIG monotherapy(0.313), and corticosteroids monotherapy (0.112). Conclusions IVIG combined with corticosteroids and IFX monotherapy demonstrated potential effect in reducing the rate of treatment failure compared to other alternative retreatment strategies. Regarding the incidence of CAL, no retreatment option showed statistically significant advantage. Consequently, while IFX demonstrated the highest probability of being the most effective option in reducing the incidence of CALs based on SUCRA values, the ranking should be interpreted with caution, given the overall absence of statistically detectable treatment differences. Clinical decisions should weigh these probabilistic findings against safety profiles and availability.