207 - INFLIXIMAB IN IVIG RESISTANT KAWASAKI DISEASE: RETROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER IN EASTERN INDIA

BACKGROUND:

10-20% of Kawasaki Disease (KD) patients do not respond to a single dose intravenous immunoglobulin (IVIG), warranting further management.

METHODOLOGY:

This is a retrospective observational study conducted at Institute of Child Health, Kolkata from January 2016 to August 2023. KD patients with persistent or recrudescent fever after 36 hours of IVIG infusion were enrolled.  These children received Infliximab (IFX) 5mg/kg to 10mg/kg single dose. Data was analysed for defervescence of fever in hours and normalization of inflammatory markers (CRP at 48 hours after IFX infusion).

Results:

240 children were diagnosed with KD during the study period, 35 (14.5%) were IVIG resistant and received IFX. 32 received infliximab and 2 received the biosimilar of infliximab. Of the IVIG resiatnt cases the median age was 23 months (IQR 27). 11 (31.4%) were  ≤12 months, 26 were males. Mean duration of illness at presentation was 6.73 ± 1.70 days. Mean duration of fever before administering IVIG was 7.48 .± 2.57 days. The median time for administration of IFX was 3 days after completion of IVIG administration.

10 of these children had coronary artery abnormality (CAA) at presentation.  

Following IFX administration, 32 became afebrile within 24 hours of IFX administration, remaining 2 within 48 hours. One patient had medium CAA on admission for whom upfront Infliximab and IVIG was given, inspite the child had persistent fever and rising size of CAA for which intravenous pulse methyl prednisolone was given and fever subsided within 24 hours of steroid. The mean CRP before IFX was 74.08mg/L and that 48 hrs after IFX was 3.96mg/L. There were no adverse reactions to IFX.

Of the 10 who had CAA at presentation, one has persistence of a small sized aneurysms. Rest all have regressed. None developed any further rise in coronary z scores on follow up

Conclusion:  

Our study cohort showed good response to IFX in IVIG resistant cases with rapid resolution of fever and normalization of raised inflammatory markers with good coronary outcome