Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease

Yusaku Nagatomo, Jun Muneuchi, Yasutaka Nakashima, Etsuro Nanishi, Hiromitsu Shirozu, Mamie Watanabe, Kiyoshi Uike, Hazumu Nagata, Yuichiro Hirata, Kenichiro Yamamura, Yasuhiko Takahashi, Seigo Okada, Yasuo Suzuki, Shunji Hasegawa, Shoichi Ohga

Research output: Contribution to journalArticle

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Abstract

Background: There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression. Methods: Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5%) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups. Results: Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24%, 24% and 24% in IFX-group, whereas 67%, 52% and 33% in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33%, 33% and 33% in IFX group, whereas 77%, 51% and 48% in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p < 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression. Conclusion: IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.

Original languageEnglish
Pages (from-to)317-321
Number of pages5
JournalInternational Journal of Cardiology
Volume271
DOIs
Publication statusPublished - Nov 15 2018

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Coronary Aneurysm
Mucocutaneous Lymph Node Syndrome
Coronary Vessels
Therapeutics
Infliximab
Intravenous Immunoglobulins
C-Reactive Protein
Fever
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease. / Nagatomo, Yusaku; Muneuchi, Jun; Nakashima, Yasutaka; Nanishi, Etsuro; Shirozu, Hiromitsu; Watanabe, Mamie; Uike, Kiyoshi; Nagata, Hazumu; Hirata, Yuichiro; Yamamura, Kenichiro; Takahashi, Yasuhiko; Okada, Seigo; Suzuki, Yasuo; Hasegawa, Shunji; Ohga, Shoichi.

In: International Journal of Cardiology, Vol. 271, 15.11.2018, p. 317-321.

Research output: Contribution to journalArticle

Nagatomo, Y, Muneuchi, J, Nakashima, Y, Nanishi, E, Shirozu, H, Watanabe, M, Uike, K, Nagata, H, Hirata, Y, Yamamura, K, Takahashi, Y, Okada, S, Suzuki, Y, Hasegawa, S & Ohga, S 2018, 'Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease', International Journal of Cardiology, vol. 271, pp. 317-321. https://doi.org/10.1016/j.ijcard.2018.04.062
Nagatomo, Yusaku ; Muneuchi, Jun ; Nakashima, Yasutaka ; Nanishi, Etsuro ; Shirozu, Hiromitsu ; Watanabe, Mamie ; Uike, Kiyoshi ; Nagata, Hazumu ; Hirata, Yuichiro ; Yamamura, Kenichiro ; Takahashi, Yasuhiko ; Okada, Seigo ; Suzuki, Yasuo ; Hasegawa, Shunji ; Ohga, Shoichi. / Effective infliximab therapy for the early regression of coronary artery aneurysm in Kawasaki disease. In: International Journal of Cardiology. 2018 ; Vol. 271. pp. 317-321.
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abstract = "Background: There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression. Methods: Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5{\%}) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups. Results: Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24{\%}, 24{\%} and 24{\%} in IFX-group, whereas 67{\%}, 52{\%} and 33{\%} in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33{\%}, 33{\%} and 33{\%} in IFX group, whereas 77{\%}, 51{\%} and 48{\%} in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p < 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression. Conclusion: IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.",
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AU - Nagatomo, Yusaku

AU - Muneuchi, Jun

AU - Nakashima, Yasutaka

AU - Nanishi, Etsuro

AU - Shirozu, Hiromitsu

AU - Watanabe, Mamie

AU - Uike, Kiyoshi

AU - Nagata, Hazumu

AU - Hirata, Yuichiro

AU - Yamamura, Kenichiro

AU - Takahashi, Yasuhiko

AU - Okada, Seigo

AU - Suzuki, Yasuo

AU - Hasegawa, Shunji

AU - Ohga, Shoichi

PY - 2018/11/15

Y1 - 2018/11/15

N2 - Background: There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression. Methods: Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5%) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups. Results: Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24%, 24% and 24% in IFX-group, whereas 67%, 52% and 33% in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33%, 33% and 33% in IFX group, whereas 77%, 51% and 48% in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p < 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression. Conclusion: IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.

AB - Background: There is limited information available regarding the role of infliximab (IFX) following the acute phase of Kawasaki disease (KD). We aimed to evaluate whether IFX is associated with coronary artery aneurysm (CAA) regression. Methods: Between 2005 and 2016, we identified 971 consecutive patients with KD from 3 tertiary institutions, and 49 (5%) with CAAs were enrolled in our study. Patients were divided into 2 groups: 27 who received IFX and 22 who did not. The persistence rate of CAAs was compared between the groups. Results: Age, sex, and duration of the febrile period did not significantly differ between the groups. The maximum value of C-reactive protein was higher in the IFX- than in the non-IFX group. The maximum z-score of CAAs did not differ between the groups. The 2-, 4- and 6-year cumulative persistence rate of CAA was 24%, 24% and 24% in IFX-group, whereas 67%, 52% and 33% in non-IFX group, respectively (P = 0.03). The median duration of CAA regression was 1.1 vs. 4.6 years. Among those who developed medium- or large-sized CAAs, the 2-, 4- and 6-year cumulative persistence rate of CAA was 33%, 33% and 33% in IFX group, whereas 77%, 51% and 48% in non-IFX group, respectively (P = 0.047). Multivariate logistic regression analysis indicated that the maximum z-score (hazard ratio 0.72, p < 0.001) and response to IFX (hazard ratio 4.56, p = 0.017) were independently related to regression. Conclusion: IFX therapy was observed to be effective for the early improvement of CAAs in patients with intravenous immunoglobulin-resistant KD.

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