Effect of additional intravenous immunoglobulin for infliximab-refractory Kawasaki disease: a cohort study.

IF 2.8 3区 医学 Q1 PEDIATRICS
Satoki Hatano, Hiro Nakao, Hiroshi Masuda, Hiroshi Ono, Mitsuru Kubota, Akira Ishiguro
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引用次数: 0

Abstract

Background: Infliximab (IFX) is a reliable choice of treatment for intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients. Nationwide surveys in Japan demonstrated that additional treatment was still required for 20-30% of patients after IFX infusion. Additional IVIG was selected for 70% as the treatment for KD refractory to IFX. This study aimed to describe the therapeutic effect of IVIG after IFX for patients with KD refractory to IFX.

Methods: A cohort study was conducted at a single center involving patients treated with additional IVIG for KD refractory to IFX between January 2016 and March 2023 (IVIG-after-IFX group). Additionally, KD patients resistant to the initial IVIG and who received a second IVIG in 2016 were included as a comparison group (second-IVIG group). We employed descriptive statistics and survival analysis to describe their clinical course information, including the time from initiation of the treatment to resolution of fever and the appearance of coronary artery lesions (CALs).

Results: The analysis included 27 cases in the IVIG-after-IFX group. The additional IVIG-after-IFX was initiated on a median 11 days of illness (range 8-29). The median time until fever resolution was 1.0 day in the IVIG-after-IFX group and 1.0 day in the second-IVIG group (P = 0.783, HR 1.00; 95% CI 0.58-1.70). The fever resolved within 2.0 days after the initiation of the therapy in 78% (21/27) in the IVIG-after-IFX group and 68% (26/38) in the second-IVIG group. CALs were identified in 26% (7/27) before initiating IVIG-after-IFX, and 7% (2/27) showed new CALs after IVIG after IFX. Persistent CALs were observed in 19% (5/27) after 12 months after diagnosis.

Conclusions: Additional IVIG for IFX-refractory KD may have a therapeutic effect comparable to that of the second IVIG for IVIG-resistant KD and be a hopeful therapeutic option for IFX-refractory KD. Treatment of IFX-refractory KD remains a challenge for us and requires further exploration, particularly regarding CAL prevention.

额外静脉注射免疫球蛋白治疗英夫利昔单抗难治性川崎病的疗效:一项队列研究
背景:英夫利昔单抗(IFX)是治疗静脉免疫球蛋白(IVIG)耐药川崎病(KD)患者的可靠选择。日本的全国性调查显示,20-30%的患者在IFX输注后仍需要额外治疗。70%的患者选择额外的IVIG作为IFX难治性KD的治疗。本研究旨在描述IVIG对IFX难治性KD患者IFX术后的治疗效果。方法:在单中心进行队列研究,纳入2016年1月至2023年3月期间接受额外IVIG治疗的难治性KD患者(IFX后IVIG组)。此外,对初始IVIG耐药并于2016年接受第二次IVIG治疗的KD患者被纳入对照组(第二次IVIG组)。我们采用描述性统计和生存分析来描述他们的临床过程信息,包括从开始治疗到发烧消退和冠状动脉病变(CALs)出现的时间。结果:纳入ifx术后ivig组27例。ifx后的额外ivig是在患病11天(范围8-29天)时开始的。ifx后ivig组发热消退的中位时间为1.0 d,第二次ivig组为1.0 d (P = 0.783, HR 1.00;95% ci 0.58-1.70)。在ivig - ifx组中,78%(21/27)和68%(26/38)的患者在开始治疗后2.0天内发烧消退。26%(7/27)的患者在IFX后进行iig治疗前发现了CALs, 7%(2/27)的患者在IFX后进行iig治疗后出现了新的CALs。在诊断后12个月,有19%(5/27)的患者出现持续的CALs。结论:额外的IVIG治疗ifx难治性KD可能具有与第二次IVIG治疗IVIG耐药KD相当的治疗效果,是ifx难治性KD的一种有希望的治疗选择。ifx难治性KD的治疗仍然是我们面临的挑战,需要进一步探索,特别是在CAL预防方面。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Rheumatology
Pediatric Rheumatology PEDIATRICS-RHEUMATOLOGY
CiteScore
4.10
自引率
8.00%
发文量
95
审稿时长
>12 weeks
期刊介绍: Pediatric Rheumatology is an open access, peer-reviewed, online journal encompassing all aspects of clinical and basic research related to pediatric rheumatology and allied subjects. The journal’s scope of diseases and syndromes include musculoskeletal pain syndromes, rheumatic fever and post-streptococcal syndromes, juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, local and systemic scleroderma, Kawasaki disease, Henoch-Schonlein purpura and other vasculitides, sarcoidosis, inherited musculoskeletal syndromes, autoinflammatory syndromes, and others.
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