Abstract 194: Neurological Prognosis Of Infliximab Therapy Against Immunoglobulin Refractory Kawasaki Disease

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Abstract

Background: Infliximab (IFX) which is an anti-TNFα monoclonal antibody is effective in the treatment of gamma globulin treatment (IVIG) resistance Kawasaki disease (KD) . It has been reported that TNFα adjusts the gene expression of myelin protein components and cause demyelination. Furthermore, at IFX treatment, the possibility of onset of the demyelinating disease in rheumatic diseases, and the exacerbation of the underlying disease in demyelinating disease have been suggested.

Objective: To evaluate the neurological prognosis in pediatric cases who underwent treatment with IFX against IVIG resistant KD, were examined for the presence or absence of demyelination and delayed myelination.

Methods: It is targeted for the 10 cases of IVIG refractory KD patients who received IFX 5mg/kg administration. Informed consent was obtained from the parents of all participants. We evaluated the candidate child’s mental development by the intelligence test (WISC-IV) and investigated the presence of demyelination and delayed myelination by brain MRI.

Results: All cases were above 6 years old, and more than a year had passed since they received medication of IFX. In all cases, abnormalities of neurological findings and psychomotor developmental delay after treatment were not observed. There was no obvious abnormality in eight cases (boys of 5 cases, girls of 3 cases, 6-11 years of age at the investigation) who underwent the WISC- IV; Full Scale IQ 97.4 ± 12.5, Verbal Comprehension Index 92.8 ± 11.9, Perceptual Reasoning Index 103.9 ± 17.9, Working Memory Index 97.1 ± 15.5, Processing Speed Index 100.9 ± 9.7. In addition, in nine cases (boys of 4 cases, girls of 5 cases, 6-16 years of age at the investigation) who underwent brain MRI, there was no evidence of demyelination and delayed myelination.

Conclusion: In this study, there were not existed the findings of demyelination, delayed myelination, and mental retardation in IFX administration cases. However, it is necessary to repeat examination how the IFX medication to children make adverse effects on central nervous system.

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