Infliximab treatment for refractory Kawasaki syndrome

被引:187
作者
Burns, JC [1 ]
Mason, WH
Hauger, SB
Janai, H
Bastian, JF
Wohrley, JD
Balfour, I
Shen, CA
Michel, ED
Shulman, ST
Melish, ME
机构
[1] Childrens Hosp San Diego, San Diego, CA USA
[2] Univ Calif San Diego, Dept Pediat, Sch Med, San Diego, CA 92103 USA
[3] Univ So Calif, Dept Pediat, Los Angeles, CA 90089 USA
[4] Pediat Specialist Med Grp, Arroyo Grande, CA USA
[5] Childrens Hosp Austin, Austin, TX USA
[6] Univ Illinois, Sch Med, Peoria, IL USA
[7] Northwestern Univ, Childrens Mem Hosp, Dept Pediat, Feinberg Sch Med, Chicago, IL 60614 USA
[8] Cardinal Glennon Childrens Hosp, St Louis, MO USA
[9] Inova Fairfax Hosp Children, Fairfax, VA USA
[10] Univ Hawaii, Dept Pediat, Honolulu, HI 96822 USA
关键词
D O I
10.1016/j.jpeds.2004.12.022
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective To evaluate the use of tumor necrosis factor (TNF)-alpha 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-alpha-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-alpha blockade in this small series of patients suggests a central role of TNF-alpha in KS pathogenesis. Controlled, randomized clinical trials are warranted to determine the role of anti-TNF-alpha therapy in KS.
引用
收藏
页码:662 / 667
页数:6
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