Infliximab for intensification of primary therapy for patients with Kawasaki disease and coronary artery aneurysms at diagnosis
© 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..
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.
DESIGN AND SETTING: Single-centre observational study.
PATIENTS: Children with acute KD and Z score ≥2.5 at baseline.
INTERVENTIONS: Primary adjunctive infliximab (5 or 10 mg/kg) within 48 hours of initiating IVIG 2 g/kg.
MAIN OUTCOME MEASURES: Incidence of CAA regression to Zmax <2 within 2 months of disease onset.
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.
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.
| Errataetall: |
CommentIn: Arch Dis Child. 2023 Oct;108(10):781-782. - PMID 37567754 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:108 |
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| Enthalten in: |
Archives of disease in childhood - 108(2023), 10 vom: 12. Okt., Seite 833-838 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Miyata, Koichi [VerfasserIn] |
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| Links: |
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| Themen: |
B72HH48FLU |
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| Anmerkungen: |
Date Completed 21.09.2023 Date Revised 06.02.2024 published: Print-Electronic CommentIn: Arch Dis Child. 2023 Oct;108(10):781-782. - PMID 37567754 Citation Status MEDLINE |
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| doi: |
10.1136/archdischild-2023-325639 |
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| PPN (Katalog-ID): |
NLM357601742 |
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| 100 | 1 | |a Miyata, Koichi |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Infliximab for intensification of primary therapy for patients with Kawasaki disease and coronary artery aneurysms at diagnosis |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 21.09.2023 | ||
| 500 | |a Date Revised 06.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Arch Dis Child. 2023 Oct;108(10):781-782. - PMID 37567754 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 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. | ||
| 520 | |a 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 | ||
| 520 | |a DESIGN AND SETTING: Single-centre observational study | ||
| 520 | |a PATIENTS: Children with acute KD and Z score ≥2.5 at baseline | ||
| 520 | |a INTERVENTIONS: Primary adjunctive infliximab (5 or 10 mg/kg) within 48 hours of initiating IVIG 2 g/kg | ||
| 520 | |a MAIN OUTCOME MEASURES: Incidence of CAA regression to Zmax <2 within 2 months of disease onset | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiology | |
| 650 | 4 | |a Infliximab | |
| 650 | 4 | |a Paediatrics | |
| 650 | 4 | |a Rheumatology | |
| 650 | 7 | |a Infliximab |2 NLM | |
| 650 | 7 | |a B72HH48FLU |2 NLM | |
| 650 | 7 | |a Immunoglobulins, Intravenous |2 NLM | |
| 700 | 1 | |a Bainto, Emelia V |e verfasserin |4 aut | |
| 700 | 1 | |a Sun, Xiaoying |e verfasserin |4 aut | |
| 700 | 1 | |a Jain, Sonia |e verfasserin |4 aut | |
| 700 | 1 | |a Dummer, Kirsten B |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Jane C |e verfasserin |4 aut | |
| 700 | 1 | |a Tremoulet, Adriana H |e verfasserin |4 aut | |
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