Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review
Kawasaki disease (KD), an autoinflammatory disease primarily affecting young children, characterized by consisting of acute systemic vasculitis and coronary artery involvement in severe cases. Intravenous immunoglobulin gamma (IVIG) combined with aspirin therapy is the first-line regimen for the pre...
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1237670/full |
| _version_ | 1827786635543052288 |
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| author | Jiaying Chen Jian Liao Lupeng Xiang Shilong Zhang Yajing Yan |
| author_facet | Jiaying Chen Jian Liao Lupeng Xiang Shilong Zhang Yajing Yan |
| author_sort | Jiaying Chen |
| collection | DOAJ |
| description | Kawasaki disease (KD), an autoinflammatory disease primarily affecting young children, characterized by consisting of acute systemic vasculitis and coronary artery involvement in severe cases. Intravenous immunoglobulin gamma (IVIG) combined with aspirin therapy is the first-line regimen for the prevention of coronary aneurysms in the acute phase of KD. The etiology and pathogenesis of KD are unclear, but its incidence is increasing gradually, especially in the cases of IVIG-naïve KD and refractory KD. Conventional therapies for refractory KD have unsatisfactory results. At present, infliximab (IFX), a human-murine chimeric monoclonal antibody that specifically blocks tumor necrosis factor-α (TNF-α), has made great progress in the treatment of KD. This review revealed that IFX infusion (5 mg/kg) could effectively modulate fever, reduce inflammation, improve arthritis, diminish the number of plasma exchange, decrease hospitalizations, and prevent the progression of coronary artery lesions. The adverse effects of IFX administration included skin rash, arthritis, respiratory disease, infusion reaction, hepatomegaly, and vaccination-associated complications. But the incidence of these adverse effects is low. The clear optimal application protocol of the application of IFX for either initial combination therapy or salvage therapy in KD is still under investigation. In addition, there are no effective biomarkers to predict IFX resistance. Further multicenter trials with large sample size and long-term follow-up are still needed to validate the clinical efficacy and safety of IFX for IVIG-resistant KD or refractory KD. |
| first_indexed | 2024-03-11T16:38:01Z |
| format | Article |
| id | doaj.art-52bc15578c384c26a1b7e4c4ec844906 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-11T16:38:01Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj.art-52bc15578c384c26a1b7e4c4ec8449062023-10-23T11:27:14ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-10-011410.3389/fimmu.2023.12376701237670Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive reviewJiaying Chen0Jian Liao1Lupeng Xiang2Shilong Zhang3Yajing Yan4Department of Pediatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, ChinaDepartment of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, Zhejiang, ChinaTaizhou University Medical School, Taizhou, Zhejiang, ChinaClinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, ChinaHealth Management Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, ChinaKawasaki disease (KD), an autoinflammatory disease primarily affecting young children, characterized by consisting of acute systemic vasculitis and coronary artery involvement in severe cases. Intravenous immunoglobulin gamma (IVIG) combined with aspirin therapy is the first-line regimen for the prevention of coronary aneurysms in the acute phase of KD. The etiology and pathogenesis of KD are unclear, but its incidence is increasing gradually, especially in the cases of IVIG-naïve KD and refractory KD. Conventional therapies for refractory KD have unsatisfactory results. At present, infliximab (IFX), a human-murine chimeric monoclonal antibody that specifically blocks tumor necrosis factor-α (TNF-α), has made great progress in the treatment of KD. This review revealed that IFX infusion (5 mg/kg) could effectively modulate fever, reduce inflammation, improve arthritis, diminish the number of plasma exchange, decrease hospitalizations, and prevent the progression of coronary artery lesions. The adverse effects of IFX administration included skin rash, arthritis, respiratory disease, infusion reaction, hepatomegaly, and vaccination-associated complications. But the incidence of these adverse effects is low. The clear optimal application protocol of the application of IFX for either initial combination therapy or salvage therapy in KD is still under investigation. In addition, there are no effective biomarkers to predict IFX resistance. Further multicenter trials with large sample size and long-term follow-up are still needed to validate the clinical efficacy and safety of IFX for IVIG-resistant KD or refractory KD.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1237670/fullKawasaki diseaseinfliximabtreatmentadverse effectTNF-α |
| spellingShingle | Jiaying Chen Jian Liao Lupeng Xiang Shilong Zhang Yajing Yan Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review Frontiers in Immunology Kawasaki disease infliximab treatment adverse effect TNF-α |
| title | Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review |
| title_full | Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review |
| title_fullStr | Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review |
| title_full_unstemmed | Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review |
| title_short | Current knowledge of TNF-α monoclonal antibody infliximab in treating Kawasaki disease: a comprehensive review |
| title_sort | current knowledge of tnf α monoclonal antibody infliximab in treating kawasaki disease a comprehensive review |
| topic | Kawasaki disease infliximab treatment adverse effect TNF-α |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1237670/full |
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