Portman MA, et al. - Since patients with Kawasaki disease may develop life-altering coronary arterial abnormalities, especially in those resistant to intravenous immunoglobulin (IVIg) therapy, researchers in this double-blind multicenter trial have tested the tumor necrosis factor α receptor antagonist etanercept to reduce both IVIg resistance and progression of coronary artery (CA) disease. For this investigation, patients with Kawasaki disease were either subcutaneously receiving etanercept (0.8 mg/kg; n = 100) or placebo (n = 101) immediately after IVIg infusion. In 22% (placebo) and 13% (etanercept) of patients, IVIg resistance occurred. In the entire population, etanercept exhibited no significant benefit in IVIg resistance, but in patients >1 year, preplanned analyses displayed benefit. Especially in patients with baseline abnormalities, etanercept appeared to improve CA dilation. There was no difference between etanercept and placebo in the safety profile.