Infliximab as rescue therapy in refractory Kawasaki disease

Rodríguez-González, Moisés; Matamala-Morillo, Miguel Ángel; Segado-Arenas, Antonio

doi:10.4103/0974-2069.126578

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Indeed, a nationwide survey of KD in Japan reported that the proportions of IVIG administrations within 5 days increased from 67.7% in 2010 to 69.2% in 2014 (4). Furthermore, slightly upward trends in use of infliximab and ulinastatin were observed in our study, probably because of the guideline recommendations for early aggressive anti-inflammatory therapy and the study results that reported the effectiveness of infliximab and ulinastatin (4,(21)(22)(23)(24). We believe that these factors may have contributed to the change in treatment strategy and reduction in risks of CAL, rather than a single effect of glucocorticoid use in the initial phase.…”

Section: Discussionmentioning

confidence: 55%

The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

et al. 2020

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Previous studies showed the efficacy of glucocorticoids on prevention of coronary artery lesions (CAL) among Kawasaki disease (KD) patients, and clinical guideline for KD in Japan was changed regarding glucocorticoid use in 2012. However, little is known regarding how the guideline change had impacts on healthcare utilizations and clinical outcomes. Methods:We conducted a retrospective observational study using national inpatient database in Japan among KD patients aged under 18 years during 2010-2015. Recent trends in practice patterns were analyzed, and we divided the hospitals into four groups based on glucocorticoid use: (1) consistently using hospital, (2) started using hospital, (3) stopped using hospital, and (4) never using hospital. Then, we compared healthcare utilizations and risks of coronary artery lesions before and after the guideline change.Results: We identified 24,517 inpatients with KD. From 2010 to 2014, use of glucocorticoid increased from 8.9 to 17.4% of KD inpatients. All types of hospitals showed reduction in coronary artery lesions, but the reduction was the most prominent in hospitals that started using glucocorticoid therapy after clinical guideline change in 2012 (adjusted OR, 0.22; 95%CI, 0.07-0.68). Also, Glucocorticoid consistently using hospitals, started using hospitals, and never using hospitals showed reductions in hospitalization costs, whereas hospitals that stopped using glucocorticoids after clinical guideline change had elevated healthcare costs as opposed to natural trends observed in other groups. Guideline complying hospitals had the greatest reductions in healthcare costs. Conclusions:The early stage glucocorticoid use could be a cost-saving strategy for treatment for KD patients without increasing risks of CAL.

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Section: Discussionmentioning

confidence: 55%

The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

et al. 2020

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“…Currently, available data so far suggests that PMIS shares a common pathophysiological pathway and overlapping symptoms with that described in KD[ 100 - 106 ]. However, clinical, laboratory, and epidemiological characteristics of PMIS appear to be different from those of KD, raising the question if they are the same entities.…”

Section: Resultsmentioning

confidence: 99%

“…As the outcomes are distinct and PMIS seems to be more aggressive, it is critical to make the subtle distinction between classical KD and PMIS. The absence of cases in Asia, the predisposition of Afro-Caribbean people, the older age of the patients, the presence of gastrointestinal symptoms in almost patients, the presence of lymphopenia/Leucopenia, the abnormal coagulation indexes, the higher levels of ferritin, D-dimer, inflammatory and cardiac markers, the higher rates of cardiogenic shock, myocardial dysfunction, PICU admission, intravenous immunoglobulin (IVIG) resistance, the requirement of advanced respiratory or circulatory support and mortality could be the main differences (Table 4 )[ 100 - 106 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most patients recovered when the severe inflammatory state associated with the SARS-CoV-2 infection is resolved. For this purpose, a high proportion of patients diagnosed as PMIS have been treated initially with IVIG (77.8%) and steroids (58%) in a similar way to KD[ 100 - 106 ]. However, to resolve this severe inflammatory state associated is challenging, as these patients exhibit an increased resistance rate to these anti-inflammatory therapies regarding those rates reported for KD.…”

Section: Resultsmentioning

confidence: 99%

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Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Rodríguez-González

Castellano-Martínez

Cascales-Poyatos³

et al. 2020

WJCC

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BACKGROUND Since the beginning of the pandemic, coronavirus disease-2019 (COVID-19) in children has shown milder cases and a better prognosis than adults. Although the respiratory tract is the primary target for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cardiovascular involvement is emerging as one of the most significant and life-threatening complications of SARS-CoV-2 infection in adults. AIM To summarize the current knowledge about the potential cardiovascular involvement in pediatric COVID-19 in order to give a perspective on how to take care of them during the current pandemic emergency. METHODS Multiple searches in MEDLINE, PubMed were performed using the search terms “COVID-19” or “SARS-CoV-2" were used in combination with “myocardial injury” or "arrhythmia" or “cardiovascular involvement” or "heart disease" or "congenital heart disease" or “pulmonary hypertension” or "long QT" or “cardiomyopathies” or “channelopathies” or "Multisystem inflammatory system" or "PMIS" or “MIS-C” or ”Pediatric multisystem inflammatory syndrome" or "myocarditis" or "thromboembolism to identify articles published in English language from January 1st, 2020 until July 31st, 2020. The websites of World Health Organization, Centers for Disease control and Prevention, and the Johns Hopkins Coronavirus Resource Center were reviewed to provide up to date numbers and infection control recommendations. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts concerning the subject were reviewed by the authors, and the data were extracted using a standardized collection tool. Data were subsequently analyzed with descriptive statistics. For Pediatric multisystemic inflammatory syndrome temporally associated with COVID-19 (PMIS), multiple meta-analyses were conducted to summarize the pooled mean proportion of different cardiovascular variables in this population in pseudo-cohorts of observed patients. RESULTS A total of 193 articles were included. Most publications used in this review were single case reports, small case series, and observational small-sized studies or literature reviews. The meta-analysis of 16 studies with size > 10 patients and with complete data about cardiovascular involvement in children with PMIS showed that PMIS affects mostly previously healthy school-aged children and adolescents presenting with Kawasaki disease-like features and multiple organ failure with a focus on the heart, accounting for most cases of pediatric COVID-19 mortality. They frequently presented cardiogenic shock (53%), ECG alterations (27%), myocardial dysfunction (52%), and coronary artery dilation (15%). Most cases required PICU admission (75%) and inotropic support (57%), with the rare need for extracorporeal membrane oxygenation (4%). Almost all of these children wholly recovered in a few days, although rare deaths have been reported (2%). Out of PMIS cases we ide...

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“…3) Gamma globulin can increase the expression of CD25 + and CD4 + through negative regulation, thereby improving the immune dysfunction due to the decrease of CD25 + and CD4 + [ 15 ]. 4) Gamma globulin reduces damage to the endovascular barrier by increasing metalloproteinase-9 and upregulating the expression of CD154 [ 16 ]. 5) Gamma globulin can reduce the immune damage in KD by blocking the LTB4-leukotriene B4 pathway [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Intravenous Immunoglobulin Gamma (IVIG) versus IVIG Plus Infliximab in Young Children with Kawasaki Disease

Han

Zhao

2018

Med Sci Monit

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BackgroundKawasaki disease (KD) is a serious disease characterized by systemic lesions of the skin and mucous membranes, as well as lymphomas and vascular inflammation. KD threatens the health and lives of children, especially young ones. Here, we compared the therapeutic effects of single intravenous immunoglobulin gamma (IVIG) vs. a combination of IVIG and infliximab in young children with Kawasaki disease (KD).Material/MethodsA total of 154 children with KD, younger than 5 years old, were enrolled in the study from January 2013 to January 2017. The patients were randomly divided into an IVIG group and a combination of IVIG and infliximab treatment group. After systematic treatments, the therapeutic indicators of the 2 groups were compared. During the treatment process, body temperature and other important inflammatory indicators, including C-reactive protein (CRP), white blood cell count (WBC), and tumor necrosis factor alpha (TNF-α), were monitored in the first 4 days.ResultsThere were fewer refractory KD patients in the combined treatment group than in the IVIG group (4 vs. 14, p<0.001). KD patients in the combined treatment group had better outcomes with shorter fever durations and hospital stays, as well as less coronary artery dilation. However, there was no obvious differences in the incidence rate of coronary artery aneurysms between the 2 groups (p>0.05). Costs of administration were similar between groups (p>0.05). Body temperature, CRP, WBC, and TNF-α in the combined therapy group all showed an earlier drop than in the IVIG group, indicating a more effective anti-inflammation effect.ConclusionThe introduction of IVIG combined with infliximab in the treatment of young children with KD has more advantages than single IVIG therapy and can be considered as a preferred treatment for KD. However, it would be necessary to further investigate whether there is a significant difference in aneurysm frequency and long-term outcome between these 2 strategies among a larger number of patients.

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Infliximab as rescue therapy in refractory Kawasaki disease

Cited by 6 publications

References 5 publications

The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

The Impact of Changes in Clinical Guideline on Practice Patterns and Healthcare Utilizations for Kawasaki Disease in Japan

Cardiovascular impact of COVID-19 with a focus on children: A systematic review

Intravenous Immunoglobulin Gamma (IVIG) versus IVIG Plus Infliximab in Young Children with Kawasaki Disease

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