Korean Circ J.  2019 Feb;49(2):183-191. 10.4070/kcj.2018.0214.

Infliximab Treatment for Intravenous Immunoglobulin-resistant Kawasaki Disease: a Multicenter Study in Korea

• Hur G
• Song MS
• Sohn S
• Lee HD
• Kim GB
• Cho HJ
• Yoon KL
• Joo CU
• Hyun MC
• Kim CH

• KMID: 2432137
• DOI: http://doi.org/10.4070/kcj.2018.0214

Abstract

BACKGROUND AND OBJECTIVES
We investigated the status of infliximab use in intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients and the incidence of coronary artery aneurysms (CAAs) according to treatment regimens.
METHODS
Between March 2010 and February 2017, 16 hospitals participated in this study. A total of 102 (32.3±19.9 months, 72 males) who received infliximab at any time after first IVIG treatment failure were enrolled. Data were retrospectively collected using a questionnaire.
RESULTS
Subjects were divided into two groups according to the timing of infliximab administration. Early treatment (group 1) had shorter fever duration (10.5±4.4 days) until infliximab infusion than that in late treatment (group 2) (16.4±4.5 days; p < 0.001). We investigated the response rate to infliximab and the incidence of significant CAA (z-score >5). Overall response rate to infliximab was 89/102 (87.3%) and the incidence of significant CAA was lower in group 1 than in group 2 (1/42 [2.4%] vs. 17/60 [28.3%], p < 0.001).
CONCLUSIONS
This study suggests that the early administration of infliximab may reduce the incidence of significant CAA in patients with IVIG-resistant KD. However, further prospective randomized studies with larger sample sizes are required.

Keyword

Kawasaki disease; Coronary artery; Infliximab; Intravenous immunoglobulins

MeSH Terms

Aneurysm
Coronary Vessels
Fever
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Incidence
Infliximab*
Korea*
Mucocutaneous Lymph Node Syndrome*
Prospective Studies
Retrospective Studies
Sample Size
Treatment Failure
Immunoglobulins
Immunoglobulins, Intravenous
Infliximab

Figure

• 

  Figure 1 Treatment modalities and response rates to infliximab and incidence of a significant CAA (z-score >5). CAA = coronary artery aneurysm; IVIG = intravenous immunoglobulin; IVMP = intravenous methyl prednisolone; MTX = methotrexate.

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