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Published on: July 27, 2021
Treatment of respiratory syncytial virus with palivizumab: a systematic review
1Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
Insights
Palivizumab is not recommended for respiratory syncytial virus (RSV) therapy. Current data does not support its use for upper or lower respiratory tract infections, necessitating further research.
Area of Science:
- Immunology
- Virology
- Pediatrics
Background:
- Palivizumab is effective for respiratory syncytial virus (RSV) prophylaxis in high-risk infants.
- Limited data exists on palivizumab's use for RSV upper respiratory tract infection (URTI) progression or severe lower respiratory tract infection (LRTI) therapy.
Purpose of the Study:
- To systematically review the literature on palivizumab's efficacy as a therapy for RSV.
- To assess clinical outcomes, including URTI to LRTI progression and survival rates.
Main Methods:
- Systematic literature review of studies on palivizumab for RSV therapy.
- Primary outcomes: URTI to LRTI progression, survival rates.
- Secondary outcomes: adverse events, serum palivizumab levels, viral load.
Main Results:
- Included 1 case report, 4 case series, 2 RCTs (136 patients).
- RCTs lacked power for clinical outcomes.
- Mortality: 12% (URTI), 6% (LRTI). Palivizumab reduced RSV concentration.
Conclusions:
- Palivizumab is not currently recommended for RSV therapy.
- Larger randomized controlled trials (RCTs) are needed to establish efficacy and safety.
Background:
Palivizumab has proven efficacy for prophylaxis of respiratory syncytial virus (RSV) in infants with prematurity or congenital heart disease. Despite a paucity of data, palivizumab is sometimes used to prevent progression when high-risk patients present with upper respiratory tract infection (URTI) due to RSV, or as therapy when any patients present with severe lower respiratory tract infection (LRTI) caused by RSV.
Methods:
A systematic review of the literatures on the use of palivizumab as therapy for RSV was conducted. The primary outcomes were progression from URTI to LRTI and survival rates. Secondary outcomes were adverse events due to palivizumab, serum palivizumab level, and RSV concentration in respiratory secretions.
Results:
The search yielded 1 case report, 4 case series, and 2 randomized controlled trials (RCTs) with a total of 136 adults and children. The RCTs were not powered to look at clinical outcomes. By combining all reported clinical outcomes, 3 (12%) of 25 patients with URTI who were given palivizumab died of RSV and 5 of 88 patients with LRTI at the time of treatment died of RSV (6%). Palivizumab levels appeared to be adequate for at least 3 weeks of intravenous injection at 15 mg/kg. The therapy resulted in decreased RSV concentrations in tracheal secretions.
Conclusion:
Larger RCTs will be required before palivizumab can be recommended as therapy for RSV in any clinical setting.
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