Key statements/findings | Level of evidencea |
---|---|
Palivizumab | |
Currently, the only product licensed for prophylaxis against RSV | Level 1 studies: 5 |
Preterm infants < 35 wGA: 68% (range 64–100%) reduction in RSVH (absolute risk reduction: 0.2–14.7%) |
Risk of biasb: low Qualityc: high |
Children with CLD/BPD: 65% (range 38–72%) reduction in RSVH (absolute risk reduction: 4.9–14.2%) | |
Children with CHD: 53% (range 45–58%) reduction in RSVH (absolute risk reduction: 4.4–4.6%) | |
Limited data in other comorbidities | |
Significantly reduced subsequent wheezing episodes |
Level 1 studies: 1 Risk of biasb: low Qualityc: high |
Ribavirin | |
Licensed for treatment of severe RSV infection | Level 1 studies: 4 |
Lack of evidence supporting its efficacy and concerns over toxicity |
Risk of biasb: unclear Qualityc: low |
Strongest evidence in immunocompromised infants | |
Future therapies | |
There are currently around 28 RSV vaccines in preclinical development and WHO estimates the availability of an RSV vaccine within 5–10 years | N/A |
Nanoparticle and subunit vaccines are the most promising for pregnant women, whereas live-attenuated, vector-based and subunit vaccines are optimal for the pediatric population | N/A |
Several new antibodies targeting the RSV fusion (F) protein are showing promise (e.g. MEI8897) and entering phase 3 trials | N/A |
Recent efforts to develop RSV antiviral drugs have focused primarily on fusion inhibitors or virus gene silencing; a number are in development and could become available for clinical use within a few years | N/A |
Key areas for research 1. Currently approved therapies More up-to-date research and published, prospective RCTs are needed to determine: The effectiveness of palivizumab in reducing RSVH and improving outcomes in children with underlying medical conditions, such as Down syndrome, cystic fibrosis, congenital airway anomalies, immunocompromising or neuromuscular disease The ultimate impact of palivizumab on longer-term sequelae, such as recurrent wheezing 2. Future therapies for prevention and treatment Continued research is needed on: Receptive strategies, such as pre- versus post-natal prophylaxis Establishing whether there is a causal link between RSV infection and asthma, possibly via a follow-on to a phase 3 vaccine or prophylaxis trial The optimal timing of therapy with antiviral drugs Whether the combination of antiviral drugs and immunomodulatory therapies might improve outcomes, as suggested by Prince et al. [216] |
N/A not applicable, RSVH respiratory syncytial virus hospitalization, RCT randomized controlled trial
aCEBM) Levels of Evidence [31, 32] where Level 1 = RCTs
bCochrane risk of bias assessment [34], where low = average of 5/7 domains assessed as low risk of bias, high = average of 5/7 domains assessed as high risk of bias, and unclear for scores inbetween (see online supplementary material for full breakdown)
cAverage Jadad score [33], where ≥ 3 = high quality (see online supplementary material for full breakdown)