Infliximab promising for treatment of Kawasaki disease

Infliximab, a monoclonal antibody, may be an effective treatment for children with Kawasaki disease, results of a recent study suggest.

Researchers with the University of California, San Diego (UCSD), School of Medicine analyzed intensification of initial therapy for all children with Kawasaki disease in order to prevent resistance to intravenous immunoglobulin (IVIG) and associated coronary artery abnormalities by assessing the addition of infliximab to current standard therapy.

Kawasaki disease is a severe childhood illness that can be mistaken for a viral infection. Signs of the disease include prolonged fever associated with rash; redness of the eyes, mouth, lips and tongue; and swollen hands and feet with peeling skin.

UCSD investigators conducted the phase 3, randomized, double-blind, placebo-controlled trial of 196 pediatric patients with Kawasaki disease and persistent fever. Compared to the patients given placebo, patients given infliximab had fewer days of fever (median one day for infliximab versus two days for placebo; P<0.0001), according to the study. At two weeks, patients treated with infliximab had greater mean reductions in erythrocyte sedimentation rate (P=0.009) and a twofold greater decrease in Z score of the left anterior descending artery (P=0.045) than those in the placebo group. This difference was not significant at week five, however.

“Children with Kawasaki disease are diagnosed by dermatologists, given the rash in the acute period of the illness and the peeling of the fingers and toes within one to two weeks from the start of the illness,” lead author Adriana H. Tremoulet, M.D., of the UCSD department of pediatrics, tells Dermatology Times. “The most significant finding of our study for dermatologists is that infliximab is safe in treating Kawasaki disease, and that in combination with the primary therapy IVIG, infliximab reduced days of hospitalization, systemic inflammation and coronary-artery inflammation faster than IVIG alone.”

The UCSD researchers conducted their trial at two centers: Rady Children’s Hospital-San Diego and Nationwide Children’s Hospital in Columbus, Ohio.

The study was published online Feb. 24 in TheLancet.