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Pediatrics Xagena

Kawasaki disease: treatment with Infliximab is safe in infants and children


Kawasaki disease ( KD ) is a severe childhood disease that many parents mistake for an inconsequential viral infection. If not diagnosed or treated in time, it can lead to irreversible heart damage.

Signs of Kawasaki disease include prolonged fever associated with rash, red eyes, mouth, lips and tongue, and swollen hands and feet with peeling skin. The disease causes damage to the coronary arteries in a quarter of untreated children and may lead to serious heart problems in early adulthood. There is no diagnostic test for Kawasaki disease, and current treatment fails to prevent coronary artery damage in at least one in 10 to 20 children and death in one in 1,000 children.

Between 10 and 20% of patients with Kawasaki disease experience fever relapse following the standard therapy with a single infusion of intravenous immunoglobulin ( IVIG ) and Acetylsalicylic acid ( Aspirin ). It is known that IVIG resistance increases the risk of heart damage, most commonly a ballooning of the coronary arteries called aneurysms. These children require additional therapy to interrupt the inflammatory process that can lead to damage of the coronary arteries.

A study led by physicians at the University of California, San Diego School of Medicine and Rady Children's Hospital-San Diego looked at intensification of initial therapy for all children with Kawasaki disease in order to prevent IVIG-resistance and associated coronary artery abnormalities by assessing the addition of the medication Infliximab ( Remicade ) to current standard therapy.
The results of the study are published in the Lancet.

Tumor necrosis factor alpha ( TNF-alpha ) is a molecule made by the body that plays a role in the development of inflammation in Kawasaki disease; therefore, treatment with a TNF-alpha antagonist is a logical therapeutic intervention.
Early experience with Infliximab, a monoclonal antibody that binds TNF-alpha, has shown promising results. A Phase 1 trial in children with Kawasaki disease and persistent fever following standard therapy found no infusion reactions or serious adverse events, and subsequent studies suggested that Infliximab led to faster resolution of fever and fewer days of hospitalization than a second IVIG infusion.

The UC San Diego researchers conducted a trial of 196 subjects at two centers to assess whether Infliximab could reduce IVIG treatment resistance.

While the addition of Infliximab to primary treatment in acute Kawasaki disease did not reduce treatment resistance, it was safe and well-tolerated, achieved a greater reduction in the size of the left coronary artery, and reduced the number of days of fever and laboratory markers of inflammation.

In conclusion, the use of Infliximab is safe in infants and children and that early treatment could help children with Kawasaki Disease with high levels of inflammation or early signs of coronary artery damage. ( Xagena )

Source: University of California - San Diego, 2014

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