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

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.

Cognitive-behavioural therapy for children with irritable bowel syndrome.

QUESTION: A child with irritable bowel syndrome (IBS) presented to the clinic with a chief concern of ongoing gastrointestinal symptoms. The parents reported no improvement despite dietary modifications and are not interested in any medications. Is cognitive-behavioural therapy (CBT) an effective treatment for IBS in children? ANSWER: Traditional CBT and its subtypes, including Internet-based CBT and gut-directed hypnotherapy, are more effective in reducing pain and gastrointestinal symptoms in children and adolescents with IBS compared with standard treatment or no treatment. This therapy should be recommended to patients and parents.

Thérapie cognitivo-comportementale pour les enfants atteints du syndrome du côlon irritable.

QUESTION: Un enfant atteint du syndrome du côlon irritable (SCI) s'est présenté à la clinique pour des symptômes gastro-intestinaux persistants comme principale raison de consulter. Les parents ont indiqué que les modifications alimentaires n'avaient pas amélioré l'état de leur enfant, et ils ne sont pas intéressés à ce qu'il reçoive des médicaments. La thérapie cognitivo-comportementale (TCC) est-elle efficace pour le traitement du SCI chez les enfants? RÉPONSE: La TCC classique et ses sous-types, y compris la TCC en ligne et l'hypnothérapie pour le syndrome du côlon irritable, sont plus efficaces pour soulager la douleur et les symptômes gastro-intestinaux que le traitement standard ou l'absence de traitement chez les enfants et les adolescents atteints du SCI. Cette thérapie devrait être recommandée aux patients et aux parents.