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Etanercept with IVIg for acute Kawasaki disease: a long-term follow-up on the EATAK trial

Published online by Cambridge University Press:  12 May 2022

Eyal Sagiv Open the ORCID record for Eyal Sagiv [Opens in a new window] ,
April Slee ,
Ashley Buffone ,
Nadine F. Choueiter ,
Nagib S. Dahdah  and
Michael A. Portman
Eyal Sagiv*
Affiliation:
Division of Pediatric Cardiology, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
April Slee
Affiliation:
University College London, London, UK
Ashley Buffone
Affiliation:
Sainte Justine University Hospital Center, University of Montreal, Montreal, Canada
Nadine F. Choueiter
Affiliation:
Children’s Hospital at Montefiore, Bronx, New York, USA
Nagib S. Dahdah
Affiliation:
Sainte Justine University Hospital Center, University of Montreal, Montreal, Canada
Michael A. Portman
Affiliation:
Division of Pediatric Cardiology, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA Seattle Children’s Research Institute, University of Washington, Seattle, Washington, USA
*
Author for correspondence: Eyal Sagiv, Division of Pediatric Cardiology, Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA. Tel: 206-987-6916; Fax: 206-987-3839. E-mail: eyal.sagiv@seattlechildrens.org
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Abstract

Background:

The 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.

Methods:

Patients 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.

Results:

Forty 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.

Discussion:

Primary 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.

Keywords

Etanercepttumour necrosis factorKawasakicoronary arteriesvasculitis
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 4 , April 2023 , pp. 613 - 618
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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