title: Infliximab treatment for refractory Kawasaki syndrome.
abstract: OBJECTIVE
  To evaluate the use of tumor necrosis factor (TNF)-alpha blockade for treatment of patients with Kawasaki syndrome (KS) who fail to become afebrile or who experience persistent arthritis after treatment with intravenous gamma globulin (IVIG) and high-dose aspirin.
  
  
  METHODS
  Cases were retrospectively collected from clinicians throughout the United States who had used infliximab, a chimeric murine/human immunoglobulin (Ig)G1 monoclonal antibody that binds specifically to human TNF-alpha-1, for patients with KS who had either persistent arthritis or persistent or recrudescent fever > or =48 hours following infusion of 2 g/kg of IVIG.
  
  
  RESULTS
  Response to therapy with cessation of fever occurred in 13 of 16 patients. C-reactive protein (CRP) level was elevated in all but one patient before infliximab infusion, and the level was lower following infusion in all 10 patients in whom it was re-measured within 48 hours of treatment. There were no infusion reactions to infliximab and no complications attributed to infliximab administration in any of the patients.
  
  
  CONCLUSIONS
  The success of TNF-alpha blockade in this small series of patients suggests a central role of TNF-alpha in KS pathogenesis. Controlled, randomized clinical trials are warranted to determine the role of anti-TNF-alpha therapy in KS.
authors.affiliation: Children's Hospital of San Diego, and Department of Pediatrics, UCSD School of Medicine, San Diego, CA, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Burns
authors.forename: Wilbert H
authors.initials: WH
authors.lastname: Mason
authors.forename: Sarmistha B
authors.initials: SB
authors.lastname: Hauger
authors.forename: Hillel
authors.initials: H
authors.lastname: Janai
authors.forename: John F
authors.initials: JF
authors.lastname: Bastian
authors.forename: Julie D
authors.initials: JD
authors.lastname: Wohrley
authors.forename: Ian
authors.initials: I
authors.lastname: Balfour
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Shen
authors.forename: Edward D
authors.initials: ED
authors.lastname: Michel
authors.forename: Stanford T
authors.initials: ST
authors.lastname: Shulman
authors.forename: Marian E
authors.initials: ME
authors.lastname: Melish
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous; D007223:Infant; D000069285:Infliximab; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D016756:Immunoglobulins, Intravenous; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D001241:Aspirin