Analysis of factors affecting efficacy and drug sensitivity of infliximab in treatment of Kawasaki disease

Yan Yun-li; Wang Xiao-meng; Yuan Jin-yu

doi:10.3969/j.issn.1672-8157.2025.01.034

Abstract：Objective To explore the efficacy of infliximab(IFX)in the treatment of Kawasaki disease(KD)and analyze the influencing factors of drug sensitivity.Methods A total of 385 KD invalids treated in Dongxing District People's Hospital and Sichuan Maternal and Child Health Hospital from March 2017 to March 2023 were selected as the research subjects and divided into two groups according to the treatment methods.The patients in the control group(n=192)received shock treatment with high-dose intravenous gamma globulin(IVIG)while those in the observation group(n=193)were treated with IFX.The clinical efficacy was compared between the two groups.According to IFX drug sensitivity,the children were further divided into the sensitive group(n=158)and insensitive group(n=35).Multivariate Logistic regression analysis was used to analyze the influencing factors of drug insensitivity in children with KD treated by IFX.Results Following a five-day treatment,the observation group achieved a total effective rate of 89.12%,surpassing the control group's rate of 73.08%.This disparity between the two groups was found to be statis-tically obvious(P<0.05).Throughout the treatment duration,the observation group reported an incidence of overall adverse reactions at 18.65%(36/193),whereas the control group experienced a rate of 20.31%(39/192).However,this difference in adverse reaction rates failed to reach statistical significance(χ2=0.080,P=0.778).The rash subsidence time,fever time,conjunctival congestion time and lymph node shrinkage time of the patients in the observation group were(2.36±0.68)d,(1.98±0.51)d,(3.19±0.67)d,and(2.98±0.67)d respectively,all of which were shorter than those of the control group((3.70±0.70)d,(2.83±0.48)d,(4.37±0.64)d,(3.72±0.46)d)(t=19.051,19.051,19.051,19.051,all P<0.05).The levels of IL-6 and neutrophil ratio in the drug-sensitive group((51.38±5.66)ng·mL-1,(52.13±10.81)%)were lower than those in the drug-insensitive group((56.41±6.07)ng·mL-1,(58.75±9.23)%)(t=4.695,3.360,P<0.001).Meanwhile,the percentage of drug sensitivity in the drug-sensitive group(56.69%)was higher than that in the non-sensitive group(40.85%)(χ2=8.639,P=0.003).Multivariate Logistic regression analysis showed that with the increase of IL-6 level and neutrophil ratio by one unit,the risk of insensitivity in IFX treatment of KD chil-dren increased by 1.141 times(95%CI:1.033-1.206,P<0.001)and 1.611 times(95%CI:1.216-2.059,P<0.001),respectively.Conclusion IFX has significant clinical effect in the treatment of children with KD,and the incidence of adverse reactions is also low.In addition,the level of IL-6 and the ratio of neutrophils in patients are closely related to the drug sensitivity of IFX in the treat-ment of children with KD and these two indexes can be used as prognostic indicators for the clinical treatment of this disease.