Infliximab for intravenous immunoglobulin resistance in Kawasaki disease: a retrospective study

J Pediatr. 2011 Apr;158(4):644-649.e1. doi: 10.1016/j.jpeds.2010.10.012. Epub 2010 Dec 3.


Objective: To test the hypothesis that first re-treatment with infliximab, compared with intravenous immunoglobulin (IVIG), might improve outcomes in IVIG-resistant Kawasaki disease.

Study design: In a two-center retrospective review from January 2000 to March 2008, we compared duration of fever and coronary artery dimensions in patients with IVIG-resistance whose first re-treatment was with IVIG compared with infliximab given for fever ≥38.0°C beyond 36 hours after first IVIG completion.

Results: Patients in the IVIG group (n = 86, 2 g/kg) and infliximab group (n = 20, 5 mg/kg) were similar in demographics, days of fever at diagnosis, and baseline coronary artery dimensions. Patients had similar coronary dimensions 6 weeks after diagnosis, both in univariate and multivariate analysis. The infliximab group had fewer days of fever (median 8 days versus10 days, P = .028), and in a multivariate analysis, the infliximab group had 1.2 fewer days of fever (P = .033). Patients who received infliximab had shorter lengths of hospitalization (median 5.5 days versus 6 days, P = .040). Treatment groups did not differ significantly in adverse events (0% versus 2.3%, P = 1.0).

Conclusions: In our retrospective study, patients with IVIG-resistant Kawasaki disease whose first re-treatment was with infliximab, compared with IVIG, had faster resolution of fever and fewer days of hospitalization. Coronary artery outcomes and adverse events were similar; the power of the study was limited.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use*
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use*
  • Child, Preschool
  • Coronary Vessels / pathology
  • Dilatation, Pathologic
  • Female
  • Hepatomegaly / chemically induced
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Infant
  • Infliximab
  • Length of Stay
  • Male
  • Mucocutaneous Lymph Node Syndrome / drug therapy*
  • Retreatment
  • Retrospective Studies
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Immunoglobulins, Intravenous
  • Tumor Necrosis Factor-alpha
  • Infliximab