-
Clinical Infectious Diseases : An... Jul 2021
Topics: Humans; Palivizumab; Respiratory Syncytial Virus, Human; Respiratory Tract Infections
PubMed: 32531025
DOI: 10.1093/cid/ciaa723 -
Molecules (Basel, Switzerland) Mar 2022Respiratory syncytial virus infection (RSVI) is an acute medical and social problem in many countries globally. Infection is most dangerous for infants under one year... (Review)
Review
Respiratory syncytial virus infection (RSVI) is an acute medical and social problem in many countries globally. Infection is most dangerous for infants under one year old and the elderly. Despite its epidemiological relevance, only two drugs are registered for clinical use against RSVI: ribavirin (approved in a limited number of countries due to side effects) and palivizumab (Synagis), which is intended only for the prevention, but not the treatment, of infection. Currently, various research groups are searching for new drugs against RSV, with three main areas of research: small molecules, polymeric drugs (proteins and peptides), and plant extracts. This review is devoted to currently developed protein and peptide anti-RSV drugs.
Topics: Aged; Antiviral Agents; Humans; Infant; Palivizumab; Peptides; Respiratory Syncytial Virus Infections; Respiratory Tract Infections
PubMed: 35408661
DOI: 10.3390/molecules27072263 -
Expert Opinion on Pharmacotherapy Apr 2023Respiratory syncytial virus (RSV) is a common respiratory virus with a huge impact on patients, the healthcare system, and society worldwide. Very few effective chances...
INTRODUCTION
Respiratory syncytial virus (RSV) is a common respiratory virus with a huge impact on patients, the healthcare system, and society worldwide. Very few effective chances of prevention and treatment of RSV infection are available.
AREAS COVERED
In this paper, knowledge on RSV characteristics and current stage of development of new pharmacological measures against this virus are discussed.
EXPERT OPINION
In recent years, the structure of RSV was explored in depth and several pharmacologic measures potentially effective for prevention and treatment of RSV infection and disease were identified. These new measures have the aim to overcome the limitations of palivizumab and ribavirin. Strategies to protect infants through immunization of pregnant women and/or the use of more effective monoclonal antibodies were developed. At the same time, it was defined which vaccines could be administered to unprimed infants to avoid the risk of enhanced respiratory disease and which vaccines could be effective in older patients and in subjects with reduced immune system efficiency. Finally, a great number of new antiviral drugs targeting the RSV proteins that allow RSV entering host cells or regulate virus replication were produced. Although further studies are needed, some preparations seem effective and safe, making the future of RSV infection prevention and treatment less gloomy.
Topics: Infant; Humans; Female; Pregnancy; Aged; Respiratory Syncytial Virus Infections; Palivizumab; Antiviral Agents; Antibodies, Monoclonal; Respiratory Syncytial Virus, Human
PubMed: 37013721
DOI: 10.1080/14656566.2023.2197590 -
Minerva Pediatrica Dec 2018Bronchiolitis is the most frequent airway infection in the first 2 years of life, and the respiratory syncytial virus (RSV) is the most frequently responsible virus. In... (Review)
Review
Bronchiolitis is the most frequent airway infection in the first 2 years of life, and the respiratory syncytial virus (RSV) is the most frequently responsible virus. In selected high-risk groups, RSV may cause severe respiratory disease leading to hospitalization, need for mechanical ventilation, and even death. These high-risk groups include children with congenital heart disease, infants with neuromuscular impairment, cystic fibrosis, Down Syndrome, immunodeficiency syndromes and others specific conditions. In these high-risk populations defined in literature as "special population", a 3- to 10-fold increase in the rate of RSV hospitalization has been observed, justifying RSV specific prophylaxis with palivizumab, a monoclonal antibody that binds a viral glycoprotein epitope and blocks the link between RSV and target cell. Evidence of safety and efficacy of RSV prophylaxis in these populations is lacking. Given the low incidence of these conditions, randomized clinical trials are not feasible. The purpose of this paper is to give an update from the literature of various conditions at higher risk to develop severe RSV infection, and to offer an overview of the efficacy of palivizumab in preventing RSV infection in these specific populations.
Topics: Antiviral Agents; Bronchiolitis; Hospitalization; Humans; Palivizumab; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Risk Factors
PubMed: 30334623
DOI: 10.23736/S0026-4946.18.05316-1 -
Paediatric Respiratory Reviews Feb 2020Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention.... (Review)
Review
Respiratory syncytial virus (RSV) infection is a leading cause of hospitalisation in early childhood and palivizumab is the only licensed intervention for prevention. Palivizumab guidelines should reflect the latest evidence, in addition to cost-effectiveness and healthcare budgetary considerations. RSV experts from Europe, Canada and Israel undertook a systematic review of the evidence over the last 5 years and developed recommendations regarding prophylaxis in industrialised countries. Almost 400 publications were reviewed. This group recommended palivizumab for: preterm infants (<29 and ≤31 weeks gestational age [wGA] and ≤9 and ≤6 months of age, respectively; high-risk 32-35wGA), former preterm children ≤24 months with chronic lung disease/bronchopulmonary dysplasia, children ≤24 months with significant congenital heart disease; and other high-risk populations, such as children ≤24 months with Down syndrome, pulmonary/neuromuscular disorders, immunocompromised, and cystic fibrosis. Up to 5 monthly doses should be administered over the RSV season. It is our impression that the adoption of these guidelines would help reduce the burden of RSV.
Topics: Antiviral Agents; Bronchopulmonary Dysplasia; Canada; Child, Preschool; Cystic Fibrosis; Developed Countries; Down Syndrome; Europe; Evidence-Based Medicine; Gestational Age; Heart Defects, Congenital; Humans; Immunocompromised Host; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Israel; Neuromuscular Diseases; Palivizumab; Patient Selection; Practice Guidelines as Topic; Respiratory Syncytial Virus Infections
PubMed: 31060948
DOI: 10.1016/j.prrv.2018.12.001 -
Pediatrics Jul 2019The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in... (Observational Study)
Observational Study
BACKGROUND
The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain.
METHODS
We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores.
RESULTS
The sample included 4267 infants; 1588 (37%) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95% confidence interval: 96.9-99.5) and did not (97.3; 95% confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab.
CONCLUSIONS
At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.
Topics: Antiviral Agents; Child; Child, Preschool; Cystic Fibrosis; Female; Follow-Up Studies; Humans; Infant; Male; Palivizumab; Registries; Respiratory Syncytial Virus Infections; Retrospective Studies; Treatment Outcome
PubMed: 31239289
DOI: 10.1542/peds.2018-3495 -
Pediatrics International : Official... Jun 2020Palivizumab is a prophylactic drug used for severe respiratory syncytial virus (RSV) infection in young children with high-risk factors, such as prematurity and...
BACKGROUND
Palivizumab is a prophylactic drug used for severe respiratory syncytial virus (RSV) infection in young children with high-risk factors, such as prematurity and congenital heart diseases. Although Japan expanded the use of palivizumab for Down syndrome (DS) in 2013 regardless of additional high-risk factors, there is not enough evidence to support its use. We analyzed health insurance claim data from the JMDC (Tokyo, Japan) to investigate the prescription pattern and efficacy of palivizumab in children with DS.
METHODS
We enrolled children of ≤24 months of age with DS at the start of the RSV epidemic season (2007-2015). We compared the risk of RSV-related admission with and without palivizumab prophylaxis using mixed effects logistic regression models accounting for patient-level clustering.
RESULTS
Of 632 children, 30% (81/268) and 83% (303/364) received palivizumab before and after the expanded program (2007-2012 and 2013-2015), respectively. Among children with DS but without additional high-risk factors (n = 135), palivizumab use surged from 0% (0/62) to 73% (53/73). In the whole study population, RSV-related hospitalization occurred in 4.2% (16/384) patients with prophylaxis and 6.0% (15/248) patients without prophylaxis. The multivariate analysis revealed that palivizumab was associated with reduced RSV-related hospitalization (odds ratio: 0.41, 95% confidence interval: 0.18-0.92, P = 0.03).
CONCLUSIONS
Virtually all children with DS in Japan have now received palivizumab, the use of which was associated with a reduction in RSV-related hospitalization in DS. Further evidence is required to clarify whether palivizumab prophylaxis should be risk-tailored or universal for DS.
Topics: Antiviral Agents; Down Syndrome; Drug Prescriptions; Female; Hospitalization; Humans; Infant; Japan; Logistic Models; Male; Palivizumab; Respiratory Syncytial Virus Infections; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 31961027
DOI: 10.1111/ped.14157 -
American Journal of Perinatology Jul 2019Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants worldwide, resulting in significant health and financial burden. Since 1998,... (Review)
Review
Respiratory syncytial virus (RSV) remains the leading cause for hospitalizations in infants worldwide, resulting in significant health and financial burden. Since 1998, the humanized monoclonal antibody palivizumab remains the only available option licensed for the prevention of severe RSV disease in high-risk children, namely premature infants and those with chronic lung disease and congenital heart disease. In 2014, the American Academy of Pediatrics modified the recommendations on the use of RSV prophylaxis in these high-risk children, and limited its use to premature infants born at < 28 weeks' gestational age (wGA). Following this last guidance update, studies have confirmed that premature infants of 29 to 34 wGA remain at high risk for severe RSV disease, especially those of younger chronologic age. New and more cost-effective strategies are being developed that would help alleviate both the health and financial burden associated with severe RSV disease.
Topics: Antibodies, Monoclonal, Humanized; Antiviral Agents; History, 20th Century; History, 21st Century; Hospitalization; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Oxygen Inhalation Therapy; Palivizumab; Respiration, Artificial; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses
PubMed: 31238362
DOI: 10.1055/s-0039-1691803 -
Pediatric Pulmonology May 2021This study aims to describe adherence rates to the 2014 American Academy of Pediatrics (AAP) Committee on Infectious Disease guidance document recommending which...
INTRODUCTION
This study aims to describe adherence rates to the 2014 American Academy of Pediatrics (AAP) Committee on Infectious Disease guidance document recommending which patients should receive palivizumab for prophylaxis against respiratory syncytial virus (RSV).
METHODS
A retrospective, single-center analysis of patients who received at least one dose of palivizumab between October 1, 2012, and March 1, 2017 was conducted. Data collected included demographics, medical history, palivizumab administration regimens, and incidence of RSV infection.
RESULTS
Data were collected on 457 patients who received palivizumab over five RSV seasons. Approximately half of the patients (45% and 55%, respectively) received palivizumab according to the AAP recommendations in place at the time (2012 or 2014 recommendations, respectively). One percent of patients had a breakthrough RSV infection after receiving at least one dose of palivizumab. There was no significant difference in the number of breakthrough infections before and after the 2014 recommendations were released (3 vs. 2).
CONCLUSIONS
Approximately half of the patients received prophylaxis in accordance with the 2014 AAP recommendations and infrequently suffered from a breakthrough RSV infection.
Topics: Antibodies, Monoclonal, Humanized; Antiviral Agents; Child; Hospitalization; Humans; Infant; Palivizumab; Pediatrics; Respiratory Syncytial Virus Infections; Respiratory Syncytial Virus, Human; Retrospective Studies; United States
PubMed: 33314771
DOI: 10.1002/ppul.25225 -
Cureus Dec 2023This systematic review and meta-analysis aimed to summarize the current evidence regarding the efficacy and safety of palivizumab as a prophylaxis for respiratory... (Review)
Review
This systematic review and meta-analysis aimed to summarize the current evidence regarding the efficacy and safety of palivizumab as a prophylaxis for respiratory syncytial virus (RSV) disease. We searched MEDLINE via PubMed, Scopus, Cochrane, Web of Science, Embase, and Science Direct from inception till November 2023. Studies that assessed the efficacy and safety of palivizumab in infants aged between 28 days and three months of age were included. We analyzed the data using Review Manager 5.4 software, with results pooled across studies and expressed as risk ratios (RR) with 95% confidence intervals (CI). A total of 10 studies were included. The effect estimates favored palivizumab over placebo regarding the hospitalization for RSV infection (RR=0.51, 95% CI: 0.40 to 0.65; P<0.00001) and ICU admission (RR=0.49, 95% CI: 0.30 to 0.81; P=0.005). On the other hand, the effect estimate showed no significant difference between palivizumab and placebo regarding all-cause mortality (RR=0.69, 95% CI: 0.42 to 1.15; P=0.16), lower respiratory tract infection (RR=0.42, 95% CI: 0.11 to 1.69; P=0.22), and need for mechanical ventilation (RR=0.75, 95% CI: 0.34 to 1.67; P=0.48). Palivizumab can be considered a prophylaxis for RSV disease in young children as it is safe, well-tolerated, and effective in reducing RSV hospitalizations. However, further research through high-quality randomized controlled trials is required to determine its efficacy as a therapeutic agent for established RSV infections.
PubMed: 38292946
DOI: 10.7759/cureus.51375