Tumor necrosis factor-α blockade for treatment of acute Kawasaki disease

Abstract

Tumor necrosis factor (TNF)-α has a key role in the development of coronary artery aneurysms in acute KD. Blockade of the TNF-α inflammatory cascade is thus a logical therapeutic aim. Infliximab, a chimeric monoclonal antibody that specifically binds TNF-α, and etanercept, a TNF-α receptor blocker, have both been used as rescue therapy for treatment-resistant KD. A prospective trial of intensification of primary therapy with infliximab in acute KD demonstrated that infliximab was safe and reduced inflammation, days of fever, and left anterior descending coronary artery diameter more rapidly than IVIG alone. A trial of etanercept as adjunctive therapy in acute KD is currently in progress.