Etanercept with IVIg for acute Kawasaki disease: a long-term follow-up on the EATAK trial.
Etanercept with IVIg for acute Kawasaki disease: a long-term follow-up on the EATAK trial.
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依那西普联合 IVIg 治疗急性川崎病：EATAK 试验的长期随访。
DOI：
10.1017/s1047951122001470
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发表时间：
2023
影响因子：
1
通讯作者：
Portman,MichaelA
中科院分区：
文献类型：
--
作者：
Sagiv,Eyal;Slee,April;Buffone,Ashley;Choueiter,NadineF;Dahdah,NagibS;Portman,MichaelA
研究背景依那西普辅助治疗急性川崎病的3期临床试验显示，依那西普可降低急性川崎病IVIg耐药的发生率。在冠状动脉受累的患者中，它减少了冠状动脉扩张的最大尺寸和短期进展。随访这一患者组，我们评估了潜在的长期效益依那西普为coronary disease.MethodsPatients随访至少1年后，试验。在每次随访访视时测量扩张动脉的大小（z评分≥ 2.5）。Z-评分和大小从基线的变化进行了评估，在每次访问和接受依那西普与安慰剂在初始trial.ResultsForty患者接受依那西普（22）或安慰剂（18）在依那西普作为辅助治疗急性川崎病试验中的患者之间进行比较。所有患者的冠状动脉尺寸测量值均持续降低：依那西普组和安慰剂组分别为6个月访视时23.3%和5.9%，1年访视时24%和13.1%，≥ 2年访视时20.8%和19.3%，冠状动脉z评分降低的结果相似。在多变量分析中，校正了患者的生长，依那西普组患者的体型缩小幅度大于安慰剂组，（p = 0.005）和1年访视（p = 0.019）在≥ 2-依那西普对急性川崎患儿的初步连续治疗并不改变冠状动脉疾病的最终结局但可促进动脉扩张的早期消退。
BackgroundThe Etanercept as Adjunctive Treatment for Acute Kawasaki Disease, a phase-3 clinical trial, showed that etanercept reduced the prevalence of IVIg resistance in acute Kawasaki disease. In patients who presented with coronary artery involvement, it reduced the maximal size and short-term progression of coronary artery dilation. Following up with this patient group, we evaluated the potential long-term benefit of etanercept for coronary disease.MethodsPatients were followed for at least 1 year after the trial. The size of dilated arteries (z-score ≥ 2.5) was measured at each follow-up visit. The z-score and size change from baseline were evaluated at each visit and compared between patients who received etanercept versus placebo at the initial trial.ResultsForty patients who received etanercept (22) or placebo (18) in the Etanercept as Adjunctive Treatment for Acute Kawasaki Disease trial were included. All patients showed a persistent decrease in coronary artery size measurement: 23.3 versus 5.9% at the 6-month visit, 24 versus 13.1% at the 1-year visit, and 20.8 versus 19.3% at the ≥ 2-year visit for etanercept or placebo, respectively, with similar results for decrease in coronary artery z-scores. In a multivariate analysis, correcting for patients’ growth, a greater size reduction for patients on the etanercept arm versus placebo was proved significant for the 6-month (p = 0.005) and the 1-year visits (p = 0.019) with a similar end outcome at the ≥ 2-year visit.DiscussionPrimary adjunctive therapy with etanercept for children with acute Kawasaki disease does not change the end outcome of coronary artery disease but may promote earlier resolution of artery dilation.