Efficacy and Limitation of Infliximab Treatment for Children with Kawasaki Disease Intractable to Intravenous Immunoglobulin Therapy: Report of an Open-label Case Series

Abstract

Eighteen of 20 patients were effectively treated with infliximab, and 2 cases were effectively treated with PE to prevent progression to coronary artery lesions. No adverse event such as anaphylactoid reaction, heart failure, severe infectious diseases, or tuberculosis was observed in this trial.

Infliximab for intensification of primary therapy for Kawasaki disease: a phase 3 randomised, double-blind, placebo-controlled trial

“…28 Since then, infl iximab has been used worldwide for treatment-resistant Kawasaki disease. 7,[29][30][31][32] These anecdotal reports of one to 20 patients all indicated a benefi t with a decrease in clinical signs including fever and markers of infl ammation. An analysis of the Paediatric Health Information System database from 2001 to 2006 showed that 14 of the 27 participating hospitals had administered infl iximab to 48 patients for treatmentresistant Kawasaki disease.…”

“…We identifi ed several reports worldwide about the use of infl iximab for treatment-resistant Kawasaki disease. 7,[28][29][30][31][32][33] A phase 1 trial of second intravenous immunoglobulin versus infl iximab for intravenous immunoglobulin-resistant Kawasaki disease showed that infl iximab was safe and well tolerated. 8 Subsequently, a retrospective review of intravenous immunoglobulin-resistant patients treated with either a second intravenous immunoglobulin or infl iximab showed that patients treated with infl iximab had fewer days of fever (median 8 vs 10 days, p=0·028) and shorter lengths of hospitalisation (median 5·5 vs 6 days, p=0·04) than those treated with a second intravenous immunoglobulin.…”

Advances in the treatment of Kawasaki disease

“…This study demonstrated that infliximab was safe and well tolerated in Kawasaki disease patients and opened the door for further studies with this agent. Additional prospective case series from Korea and Japan have also demonstrated the efficacy of infliximab in 13 of 16 (81%) and 18 of 20 (90%) IVIG-resistant Kawasaki disease patients, respectively [40,41]. A recent, two-center, US retrospective review of IVIG-resistant patients treated with either second-line IVIG (n ¼ 86) or infliximab (n ¼ 20) demonstrated that patients treated with infliximab had statistically significantly fewer days of fever and shorter lengths of hospitalization, with similar coronary artery outcomes [42 & ].…”

Pathogenesis of Systemic Inflammatory Diseases in Childhood: ?Lessons From Clinical Trials of Anti-Cytokine Monoclonal Antibodies for Kawasaki Disease, Systemic Onset Juvenile Idiopathic Arthritis, and Cryopyrin-Associated Periodic Fever Syndrome?

“…Subsequently, we performed an open-label trial of infliximab in 20 cases unresponsive to IVGG [39]. This clinical trial was characterized by rescue plasma exchange planned to be implemented in patients where IVGG-infliximab failed.…”