Infliximab treatment for Kawasaki disease

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Intravenous immunoglobulin (IVIG) has been shown by randomized controlled clinical trials to be an effective treatment for Kawasaki disease. Unfortunately, IVIG is not successful in all cases. Because tumor necrosis factor-alpha (TNF-alpha) is often elevated in patients with acute Kawasaki disease, it is possible that TNF-alpha blockade also could be a useful treatment. In this issue of The Journal, Burns et al present the results of a randomized controlled clinical trial of a second infusion of IVIG versus treatment with infliximab in children with Kawasaki disease who were resistant to a first dose of IVIG. They found that in most patients, both treatments were safe and led to cessation of fever within 24 hours. Further research is needed, but infliximab might be considered as an alternative to additional infusions of IVIG or treatment with corticosteroids when a first dose of IVIG is unsuccessful in the treatment of Kawasaki disease.