Background: Infliximab (IFX) which is an anti-TNFα monoclonal antibody is effective in the treatment of gamma globulin treatment (IVIG) resistance Kawasaki disease (KD) . On the other hand, plasma exchange therapy (PE) became insurance adaptation as treatment for IVIG-resistant KD in Japan. It is necessary to clarify the position of IFX as an additional treatment for IVIG-resistant KD.
Purpose: We examined retrospectively the efficacy of IFX for IVIG-resistant KD and discussed its adaptation.
Method: We studied 30 cases (boys 18 cases, 12 cases of girls) who underwent IFX treatment in our hospital because they were IVIG-resistant KD. Between the invalid group and the effective group of IFX treatment, we compared the age , gender, the time of administration, the sick days, CRP value and the presence or absence of coronary artery lesions (CAL) before the treatment in patients.
Result: Clinical symptoms and laboratory data has improved in 22 cases of the 30 cases, but 8 cases underwent plasma exchange because IFX was invalid. Compared to the disabled group and effective group of IFX, the proportion with CAL was significantly higher in the disabled group (87.5% invalid group 40.9% vs effective group, p <0.05). There was no significant other factor between the two group.
Discussion: We have to suppressed the inflammation in order to inhibit CAL. To do so, the enforcement period and selection of additional treatment are important. Because treatable facility is limited, PE is not able to carry out in all cases. In this study, the possibility that can predict efficacy of IFX by the presence or absence of CAL in the IVIG-resistant KD has been shown. we should clarify the adaptation of IFX by continuing further study to find the relevant factors.