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Infliximab for intensification of primary therapy for patients with Kawasaki disease and coronary artery aneurysms at diagnosis.
- Source :
-
Archives of disease in childhood [Arch Dis Child] 2023 Oct; Vol. 108 (10), pp. 833-838. Date of Electronic Publication: 2023 May 31. - Publication Year :
- 2023
-
Abstract
- Objective: Children with Kawasaki disease (KD) and an initial echocardiogram that demonstrates coronary artery aneurysms (CAAs, Z score ≥2.5) are at high risk for severe cardiovascular complications. We sought to determine if primary adjunctive infliximab treatment at a dose of either 5 or 10 mg/kg, compared with intravenous immunoglobulin (IVIG) alone, is associated with a greater likelihood of CAA regression in patients with KD with CAA at the time of diagnosis.<br />Design and Setting: Single-centre observational study.<br />Patients: Children with acute KD and Z score ≥2.5 at baseline.<br />Interventions: Primary adjunctive infliximab (5 or 10 mg/kg) within 48 hours of initiating IVIG 2 g/kg.<br />Main Outcome Measures: Incidence of CAA regression to Zmax <2 within 2 months of disease onset.<br />Results: Of the 168 patients with KD, 111 received IVIG alone and 57 received primary adjunctive infliximab therapy: 39 received 5 mg/kg and 18 received 10 mg/kg. Incidence of CAA regression to Zmax <2 within 2 months was statistically significant at 52%, 62% and 83% in the IVIG alone, IVIG+infliximab 5 mg/kg and IVIG+infliximab 10 mg/kg, respectively. The multivariable logistic regression model adjusting for age, sex, baseline Zmax and bilateral CAA at baseline showed that IVIG plus 10 mg/kg infliximab was significantly associated with a greater likelihood of CAA regression (adjusted OR: 4.45, 95% CI 1.17 to 16.89, p=0.028) compared with IVIG alone. The difference between IVIG+infliximab 5 mg/kg and IVIG alone was not significant.<br />Conclusions: Primary adjunctive high-dose 10 mg/kg infliximab treatment was associated with a greater likelihood of CAA regression in patients with CAA at the time of diagnosis.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Child
Humans
Infant
Infliximab therapeutic use
Immunoglobulins, Intravenous therapeutic use
Coronary Vessels
Retrospective Studies
Mucocutaneous Lymph Node Syndrome complications
Mucocutaneous Lymph Node Syndrome diagnosis
Mucocutaneous Lymph Node Syndrome drug therapy
Coronary Aneurysm drug therapy
Coronary Aneurysm etiology
Coronary Aneurysm diagnosis
Coronary Artery Disease drug therapy
Coronary Artery Disease etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2044
- Volume :
- 108
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Archives of disease in childhood
- Publication Type :
- Academic Journal
- Accession number :
- 37258054
- Full Text :
- https://doi.org/10.1136/archdischild-2023-325639