Infliximab is the new kid on the block in Kawasaki disease: a single-centre study over 8 years from North India

Abstract

This was a single-centre study to evaluate the usefulness of tumour necrosis factor-α (TNF-α) blocker, infliximab (IFX), for treatment of Kawasaki disease (KD) in children in Northern Indian. The study was carried out in the Paediatric Allergy-Immunology Unit, Advanced Paediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh. The study period was January 2007 to March 2015. Review of records of 23 children with KD who had received IFX was carried out. Median age at presentation was 2 years (range 2 months to 12 years). Indications for using IFX were intravenous immunoglobulin (IVIg) resistance (12/23 patients); severe KD especially when coronary artery abnormalities (CAAs) had developed in spite of IVIg (9/23 patients); retinal vasculitis in association with KD (1 patient) and economic reasons (1 patient). Twenty one (21/23) patients had received IVIg (2 g/kg) as first line therapy. A dose of IFX was 5-7 mg/kg given intravenously. Screening tests for tuberculosis (chest xray, Tuberculin test, QuantiFERON-TB Gold test) were not carried out prior to IFX infusion in any patient. Duration of follow-up was 0-20 months in 13 patients; 21-40 months in 5 patients and >40 months in 6 patients. Mean follow-up was 28.78±25.49 months, range 1-84 months. Eleven of 12 patients (11/12) who had IVIg resistance showed prompt resolution with IFX. Nineteen patients (19/23) in the cohort had CAAs. Of these, 12 showed improvement over mean follow-up of 28.78±25.49 months (range 1-84 months) and 4 showed normalisation. No adverse reactions were noted during infusion of IFX. On follow-up, none of these patients has developed tuberculosis or any other significant infection over a cummulative follow-up of 662 months. IFX can be considered as a useful adjunct in treatment of children with KD.