Refractory Kawasaki disease: Infliximab or methotrexate therapy?

Abstract

However, infliximab is very expensive to use as a second-line drug in refractory KD in developing countries. Therefore, one of our authors have previously used low-dose oral methotrexate as a treatment for patients with refractory KD.2 In his study, methotrexate treatment resulted in rapid defervescence, improvement in clinical symptoms, normalizationm of acute-phase reactants, and no progression of coronary artery dilatation in severe KD patients resistant to additional IVIG and intravenous dexamethasone.2 Methotrexate was also discontinued with no recurrence of fever in all patients.2 Because methotrexate is cheap, easy to administer (oral, weekly), easily available and less toxic than infliximab, it could effectively be used before applying infliximab to KD patients refractory to additional IVIG or high-dose steroid therapy.