Favorable coronary outcomes following IL-6 blockade with tocilizumab in IVIG-resistant kawasaki disease: a case series

In this series, late administration of TCZ during the subacute phase was associated with a rapid anti-inflammatory response and favorable coronary remodeling, including aneurysm regression. This outcome contrasts with previous reports of coronary dilation following earlier intervention. Critically, these observations lead us to propose a "phase-dependent efficacy" hypothesis: the timing of IL-6 blockade relative to disease stage may be a critical determinant of coronary outcomes. This hypothesis underscores the need to consider the disease phase when evaluating IL-6 blockade for refractory KD.