Infliximab treatment for refractory Kawasaki syndrome

Jane C. Burns, Wilbert H. Mason, Sarmistha B. Hauger, Hillel Janai, John F. Bastian, Julie D. Wohrley, Ian Balfour, Cynthia A. Shen, Edward D. Michel, Stanford T. Shulman, Marian E. Melish

Research output: Contribution to journalArticlepeer-review

206 Scopus citations

Abstract

Objective: To evaluate the use of tumor necrosis factor (TNF)-α 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-α-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-α blockade in this small series of patients suggests a central role of TNF-α in KS pathogenesis. Controlled, randomized clinical trials are warranted to determine the role of anti-TNF-α therapy in KS.

Original languageEnglish (US)
Pages (from-to)662-667
Number of pages6
JournalJournal of Pediatrics
Volume146
Issue number5
DOIs
StatePublished - May 2005

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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