Infliximab Treatment for Pediatric Refractory Kawasaki Disease

Blaisdell, Laura; Hayman, Jennifer; Moran, Adrian M.

doi:10.1007/s00246-011-0045-2

Cited by 10 publications

(4 citation statements)

References 29 publications

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“…The TNF alpha blockers (such as infliximab) and platelet glycoprotein Ibis/Imia receptor inhibitors (such as abciximab), seem to benefit KD patients, especially those patients/cases refractory to IVIG and those patients who developed aneurysms. Concerning infliximab administration, it is currently increasing for KD patients with recrudescent fever or persistently elevated inflammatory markers to prevent coronary aneurysm and stricture formation and a dose of 4.8 mg/kg, diluted in 250 mL of normal saline, may be suggested [29, 32–35]. Instead, abciximab administration is commonly used to prevent thrombosis and to decrease aneurysm size in patients with large coronary artery aneurysms [36].…”

Section: Kawasaki Diseasementioning

confidence: 99%

Recent Understanding on Diagnosis and Management of Central Nervous System Vasculitis in Children

Iannetti

Zito

Bruschi

et al. 2012

Clinical and Developmental Immunology

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Central nervous system vasculitides in children may develop as a primary condition or secondary to an underlying systemic disease. Many vasculitides affect both adults and children, while some others occur almost exclusively in childhood. Patients usually present with systemic symptoms with single or multiorgan dysfunction. The involvement of central nervous system in childhood is not frequent and it occurs more often as a feature of subtypes like childhood polyarteritis nodosa, Kawasaki disease, Henoch Schönlein purpura, and Bechet disease. Primary angiitis of the central nervous system of childhood is a reversible cause of severe neurological impairment, including acute ischemic stroke, intractable seizures, and cognitive decline. The first line therapy of CNS vasculitides is mainly based on corticosteroids and immunosuppressor drugs. Other strategies include plasmapheresis, immunoglobulins, and biologic drugs. This paper discusses on current understanding of most frequent primary and secondary central nervous system vasculitides in children including a tailored-diagnostic approach and new evidence regarding treatment.

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Section: Kawasaki Diseasementioning

confidence: 99%

Recent Understanding on Diagnosis and Management of Central Nervous System Vasculitis in Children

Iannetti

Zito

Bruschi

et al. 2012

Clinical and Developmental Immunology

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“…(17,18) Infliximab is a monoclonal antibody against TNF alpha and as such carries potential side-effects of immunosuppression or immune reactions. The rationale behind its use relates to suppressing the pro-inflammatory cytokines such as TNF-α, interleukins and endothelial growth factor that are elevated during the acute phase of KD.…”

Section: Discussionmentioning

confidence: 99%

Refractory, missed and severe Kawasaski disease: Diagnostic and therapeutic challenges

Comitis

Lawrenson

Schalkwyk³

et al. 2017

SAHJ

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have however reduced the acute mortality rate from about 2% in the 1970s to less than 0.2%. This article reports on a recent cluster of KD patients seen at 2 hospitals in Cape Town. Each case highlights a particular learning point or challenge in the diagnosis or management. CASE 1 -SEVERE KDA 15-month-old previously well boy was admitted with diarrhoea and vomiting, cough and fever which had persisted for 4 days. On examination he was lethargic with a temperature of 38.6°C and an

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“…Despite 50 years of research, the mechanism of KD is still not well understood. Many studies have shown that KD may be related to infection and autoimmune allergy [ 2 , 3 ]. The clinical manifestations of KD are sustained high fever, severe skin mucosal damage, systemic vascular inflammatory lesions, and severe lesions involving the vital organs, especially the coronary arteries [ 4 ], greatly increasing the risk of myocardial infarction and threatening the lives of these children.…”

Section: Introductionmentioning

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 Treatment for Pediatric Refractory Kawasaki Disease

Cited by 10 publications

References 29 publications

Recent Understanding on Diagnosis and Management of Central Nervous System Vasculitis in Children

Recent Understanding on Diagnosis and Management of Central Nervous System Vasculitis in Children

Refractory, missed and severe Kawasaski disease: Diagnostic and therapeutic challenges

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

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