26 research outputs found
Infliximab versus second intravenous immunoglobulin for treatment of resistant Kawasaki disease in the USA (KIDCARE): a randomised, multicentre comparative effectiveness trial
Background
Although intravenous immunoglobulin (IVIG) is effective therapy for Kawasaki disease, 10–20% of patients have recrudescent fever as a sign of persistent inflammation and require additional treatment. We aimed to compare infliximab with a second infusion of IVIG for treatment of resistant Kawasaki disease.
Methods
In this multicentre comparative effectiveness trial, patients (aged 4 weeks to 17 years) with IVIG resistant Kawasaki disease and fever at least 36 h after completion of their first IVIG infusion were recruited from 30 hospitals across the USA. Patients were randomly assigned (1:1) to second IVIG (2 g/kg over 8–12 h) or intravenous infliximab (10 mg/kg over 2 h without premedication), by using a randomly permuted block randomisation design with block size of two or four. Patients with fever 24 h to 7 days following completion of first study treatment crossed over to receive the other study treatment. The primary outcome measure was resolution of fever at 24 h after initiation of study treatment with no recurrence of fever attributed to Kawasaki disease within 7 days post-discharge. Secondary outcome measures included duration of fever from enrolment, duration of hospitalisation after randomisation, and changes in markers of inflammation and coronary artery Z score. Efficacy was analysed in participants who received treatment and had available outcome values. Safety was analysed in all randomised patients who did not withdraw consent. This clinical trial is registered with ClinicalTrials.gov, NCT03065244.
Findings
Between March 1, 2017, and Aug 31, 2020, 105 patients were randomly assigned to treatment and 103 were included in the intention-to-treat population (54 in the infliximab group, 49 in the second IVIG group). Two patients randomised to infliximab did not receive allocated treatment. The primary outcome was met by 40 (77%) of 52 patients in the infliximab group and 25 (51%) of 49 patients in the second IVIG infusion group (odds ratio 0·31, 95% CI 0·13–0·73, p=0·0076). 31 patients with fever beyond 24 h received crossover treatment: nine (17%) in the infliximab group received second IVIG and 22 (45%) in second IVIG group received infliximab (p=0·0024). Three patients randomly assigned to infliximab and two to second IVIG with fever beyond 24h did not receive crossover treatment. Mean fever days from enrolment was 1·5 (SD 1·4) for the infliximab group and 2·5 (2·5) for the second IVIG group (p=0·014). Mean hospital stay was 3·2 days (2·1) for the infliximab group and 4·5 days (2·5) for the second IVIG group (p<0·001). There was no difference between treatment groups for markers of inflammation or coronary artery outcome. 24 (44%) of 54 patients in the infliximab group and 33 (67%) of 49 in the second IVIG group had at least one adverse event. A drop in haemoglobin concentration of at least 2g/dL was seen in 19 (33%) of 58 patients who received IVIG as either their first or second study treatment (three of whom required transfusion) and in three (7%) of 43 who received only infliximab (none required transfusion; p=0·0028). Haemolytic anaemia was the only serious adverse events deemed definitely or probably related to study treatment, and was reported in nine (15%) of 58 patients who received IVIG as either their first or second study treatment and none who received infliximab only.
Interpretation
Infliximab is a safe, well tolerated, and effective treatment for patients with IVIG resistant Kawasaki disease, and results in shorter duration of fever, reduced need for additional therapy, less severe anaemia, and shorter hospitalisation compared with second IVIG infusion
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Spring Precipitation as a Predictor for Peak Standing Crop of Mixed-Grass Prairie
Ranchers and range managers need a decision support tool that provides a reasonably accurate prediction of forage growth potential early in the season to help users make destocking decisions. Erroneous stocking rate decisions can have dire economic and environmental consequences, particularly when forage production is low. Predictions must be based on information that is easily obtained and relevant to the particular range. Our goal was to evaluate monthly precipitation in spring months as a potential predictor of forage production compared to annual and growing-season precipitation. We analyzed the relationships between grazed and ungrazed peak standing crop (PSC) and precipitation using nonlinear regression and a plateau model, Akaike’s information criterion for model selection, and data from three locations: Streeter, North Dakota; Miles City, Montana; and Cheyenne, Wyoming. The plateau model included a linear segment, representing precipitation limiting production, and a plateau, an estimate of average production when precipitation is no longer the limiting factor. Both the response and predictor variables were rescaled so variability in production from average production was related to variability in precipitation from the long-term average. We found that grazing did not affect the relationship between PSC and precipitation, nor were annual or growing-season precipitation good predictor variables. The best predictor variable was total precipitation in April and May for Montana, May and June for North Dakota, and April, May, and June for Wyoming, with r2 ranging from 0.74 to 0.79 for precipitation less than long-term average. These results indicate that spring precipitation provides useful information for destocking decisions and can potentially be used to develop a decision support tool, and the results will guide our choice of possible predictor models for the tool.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202