Infliximab for the treatment of Kawasaki disease

Matsubara, Tomoyo

doi:10.1111/ped.13663

Cited by 6 publications

(4 citation statements)

References 7 publications

(6 reference statements)

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“…There is a relationship between the use of adjuvant therapy with anti-TNF-α drugs and the improvement in persistent symptoms, as well as no progression of coronary lesions. In patients with coronary aneurysms, upregulation of regulatory T cells with downregulation of activated monocytes and increased plasma concentrations of TNF-α receptors have been reported, supporting the use of blockers as adjuvant therapy 12 .…”

Section: Discussionmentioning

confidence: 90%

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Immunoglobulin-resistant Kawasaki disease

Marriaga-Núñez,

Arellano-Valdez,

Abarca-de la Paz

et al. 2023

BMHIM

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Background: Kawasaki disease is a systemic vasculitis that affects small and medium-sized vessels, primarily the coronary arteries. First-line treatment includes intravenous immunoglobulin (IVIG) and acetylsalicylic acid; however, 20% do not respond adequately despite treatment. We describe a case treated with etanercept after initial IVIG failure, showing a good response. Case report: A 5-year-old female was diagnosed with classic Kawasaki disease. Echocardiography and angiotomography revealed giant and fusiform aneurysms in the coronary arteries. A first dose of IVIG therapy was administered without improvement; after the second dose, the fever persisted, so etanercept was administered, and the fever subsided. There were no new lesions in medium-caliber vessels and the previously identified coronary lesions did not progress. Conclusions: The use of etanercept in Kawasaki disease has demonstrated a clinically favorable response. Controlled clinical trials of this drug are needed to establish it as a formal therapy in cases of initial IVIG failure.

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Section: Discussionmentioning

confidence: 90%

“…The first TNF-α antagonist monoclonal antibody used was infliximab, although the results were not convincing 11,12 . Another drug used is etanercept, which has been shown to reduce immunoglobulin resistance and prevent the appearance and progression of coronary aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Immunoglobulin-resistant Kawasaki disease

Marriaga-Núñez,

Arellano-Valdez,

Abarca-de la Paz

et al. 2023

BMHIM

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“…It might be helpful for the early administration of additional treatments, such as steroids and/ or biologics to prevent severe coronary arterial involvement. 40,41 Although there is not a specific biomarker defined for KD and its complications, there has been a great focus on many laboratory markers and their threshold values for predicting increased CALs development. Higher ESR and CRP values were associated with elevated risks for CALs indicating severe inflammation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for coronary arterial involvement in Turkish children with Kawasaki disease: a multicenter retrospective study

et al. 2023

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“…KD patients who develop CAA have a defect in expansion of both natural Treg and tolerogenic myeloid dendritic cells (15). Infliximab can downregulate activated monocytes and upregulate Treg toward the normal range (16).…”

Section: Discussionmentioning

confidence: 99%

Resolution of Giant Coronary Aneurisms in a Child With Refractory Kawasaki Disease Treated With Anakinra

et al. 2020

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Kawasaki disease (KD) is an acute, febrile illness of unknown etiology that mainly affects children under 5 years of age. intravenous immunoglobulin (IVIG), the standard treatment, has reduced coronary involvement to <5%. Patients who do not improve after an initial IVIG have a higher risk of developing coronary arteries aneurysms, and its optimal treatment remains controversial. We present a case of IVIG, steroids, and infliximab-resistant KD in a 9-month-old child, which developed giant aneurysms and was successfully treated with anakinra, a recombinant antagonist of the IL-1 receptor. In our case, the introduction of IL-1 receptor antagonist therapy seems to have blocked the disease from both a clinical and a laboratory point of view. We also noted a very rapid regression of coronary aneurysms passed from giant aneurysms to small ones, or, as in the case of the anterior descending artery, the complete disappearance of the aneurysm formation. We think that our case adds more evidences to the potential role of IL-1RA as therapy in some selected cases of refractory KD, in particular with severe involvement of coronary arteries, although new efficacy trials are needed to better understand the role of Anakinra in these patients.

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Infliximab for the treatment of Kawasaki disease

Cited by 6 publications

References 7 publications

Immunoglobulin-resistant Kawasaki disease

Immunoglobulin-resistant Kawasaki disease

Risk factors for coronary arterial involvement in Turkish children with Kawasaki disease: a multicenter retrospective study

Resolution of Giant Coronary Aneurisms in a Child With Refractory Kawasaki Disease Treated With Anakinra

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