Efficacy Of Intravenous Immunoglobulin For Hand, Foot And Mouth Disease:a Systematic Review

Objective:To systematically review the effectivity of intravenous imm unoglobulin for children with hand, foot and mouth disease.Method:Databases including cochrane central register of controlled tri als, pubmed, embase, CNKI, CBM, Chongqinq VIP database, Wanfang dat abase were searched to collect randomized controlled trials about IVIG co mbined with conventional therapy versus conventional therapy for hand, fo od and mouth disease. No language limitation. All relevant studies were c ompiled up to March 2016. Two reviewers screened studies, extracted dat a, assessed the risk of bias, evaluate quality of evidence, independently. St atistical analyses were performed using RevMan 5.3 software.Result: ①A total 9 studies (989 patients, treatment group 571 patient s/control group 418 patients) reported severity rate. The results of meta-an alysis showed that compared with the conventional therapy group, the IVI G combined with conventional therapy group had lower severity rate (RR =0.32,95%CI [0.21,0.49], P<0.00001), with a low heterogeneity (I2=0%, P=0.92). Subgroup treated with large dose of IVIG (1g/(kg.d)) included 3 studies (444 patients, treatment group 252 patients/control group 192 pati ents).The results of meta-analysis showed that the IVIG combined with co nventional therapy group had lower severity rate (RR=0.33,95%CI [0.17, 0.66], P=0.002), with a low heterogeneity (I2=0%, P=0.43). Subgroup treat ed with small dose of IVIG (0.4g/(kg.d)) included 3 studies (193 patient s, treatment group 98 patients/control group 95 patients). The results of m eta-analysis showed that the IVIG combined with conventional therapy gro up had lower severity rateRR=0.42,95%CI [0.20,0.89], P=0.02), with a 1 ow heterogeneity (I2=0%, P=0.82). Subgroup treated with unclear dose of IVIG included 3 studies (352 patients, treatment group 221 patients/control group 131 patients). The results of meta-analysis showed that the IVIG c ombined with conventional therapy group had lower severity rate (RR=0.3 7,95%CI [0.16,0.85], P=0.02), with a low heterogeneity (I2=0%, P=0.38). (?) ② A total 4 studies (480 patients, treatment group 275 patients/control g roup 205 patients) reported mortality rate. The results of meta-analysis sh owed that compared with the conventional therapy group, the IVIG combi ned with conventional therapy group had lower mortality rate (RR=0.21,9 5%CI [0.05,0.83], P=0.03), with a low heterogeneity (I2=0%, P=0.61). Th e quality of evidence for severity rate was medium, for mortality rate was 1 ow. ③There are 5 studies reported the adverse drug reaction, shiver, fever, hypotension, acute urticaria, nausea, polypnea were incidental.Conclusions:IVIG treatment can decrease the severity rate for children with hand, foot and mouth disease. IVIG treatment possibly could decrease the mortality for children with hand, foot and mouth disease. Different dose of IVIG treatment can decrease the severity rate for children with hand, foot and mouth disease. In most cases treated by immunoglobulin is safe for patients.