Infliximab treatment for refractory Kawasaki syndrome - 15/08/11

Doi : 10.1016/j.jpeds.2004.12.022

Jane C. Burns, MD, Wilbert H. Mason, MD, Sarmistha B. Hauger, MD, Hillel Janai, MD, John F. Bastian, MD, Julie D. Wohrley, MD, Ian Balfour, MD, Cynthia A. Shen, MD, Edward D. Michel, MD, Stanford T. Shulman, MD, Marian E. Melish, MD
From Children's Hospital of San Diego and Department of Pediatrics, UCSD School of Medicine, San Diego; the Department of Pediatrics, University of Southern California, Los Angeles; The Pediatric Specialist Medical Group, Arroyo Grande, California; Children's Hospital of Austin, Texas; University of Illinois School of Medicine, Peoria; the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, Illinois; Cardinal Glennon Children's Hospital, St. Louis, Missouri; Inova Fairfax Hospital for Children, and Haymarket Pediatrics, Falls Church, Virginia; and the Department of Pediatrics, University of Hawaii, Honolulu

Abstract

Objective

To evaluate the use of tumor necrosis factor (TNF)-⍺ blockade for treatment of patients with Kawasaki syndrome (KS) who fail to become afebrile or who experience persistent arthritis after treatment with intravenous gamma globulin (IVIG) and high-dose aspirin.

Study design

Cases were retrospectively collected from clinicians throughout the United States who had used infliximab, a chimeric murine/human immunoglobulin (Ig)G1 monoclonal antibody that binds specifically to human TNF-⍺-1, for patients with KS who had either persistent arthritis or persistent or recrudescent fever ≥48 hours following infusion of 2 g/kg of IVIG.

Results

Response to therapy with cessation of fever occurred in 13 of 16 patients. C-reactive protein (CRP) level was elevated in all but one patient before infliximab infusion, and the level was lower following infusion in all 10 patients in whom it was re-measured within 48 hours of treatment. There were no infusion reactions to infliximab and no complications attributed to infliximab administration in any of the patients.

Conclusion

The success of TNF-⍺ blockade in this small series of patients suggests a central role of TNF-⍺ in KS pathogenesis. Controlled, randomized clinical trials are warranted to determine the role of anti-TNF-⍺ therapy in KS.

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Mots-clés : ASA, CAA, CRP, eNOS, Ig, IVIG, KS, TNF

Plan

Methods

Results

Patient Characteristics

Therapy

Patient Outcome

Discussion

Jane C. Burns is the Principal Investigator of a grant from Centocor for an investigator-initiated clinical trial of infliximab in Kawaski syndrome. Other co-author participants in the Phase I clinical trial are Stanford T. Shulman and Marian E. Melish.
Reprint requests: No reprints available.

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Vol 146 - N° 5

P. 662-667 - mai 2005 Retour au numéro

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Infliximab treatment for refractory Kawasaki syndrome - 15/08/11

Abstract

Objective

Study design

Results

Conclusion

Plan

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