Study Finds 3 Monoclonal Antibodies Reduce RSV Infections in High-Risk Infants, Children

A recent investigation found that nirsevimab, palivizumab, and motavizumab were associated with a significant reduction in infections related to respiratory syncytial virus (RSV) and hospitalizations per 1000 participants.¹

Motavizumab and palivizumab were also associated with significant reductions in intensive care unit admissions and supplemental oxygen use per 1000 participants, while nirsevimab was associated with significantly reduced supplemental oxygen use.

Respiratory syncytial virus is a common and highly contagious virus that can cause severe lower respiratory infections, especially in children under the age of 5. Currently, the condition lacks an effective vaccine, leaving preventative measures limited.

Because of this, Mingyao Sun Department of Intensive Care Unit, The First Hospital of Lanzhou University, and a team of investigators, compared the efficacy and safety of monoclonal antibodies for the prevention of respiratory syncytial virus infection in infants and children.

Respiratory Syncytial Virus Therapy: Nirsevimab, Palivizumab, Motavizumab

After analyzing data from 15 randomized clinical trials involving 18,395 participants, results showed no significant differences in all-cause mortality or drug-related adverse events between the monoclonal antibody treatments and placebo. However, supatavumab did not show any significant benefits for the outcomes of interest.

According to the study, these findings suggest that nirsevimab, palivizumab, and motavizumab are effective in preventing respiratory syncytial virus infection and related hospitalizations without increasing the risk of adverse events in infants and children at high risk for RSV infection.

This is important because respiratory syncytial virus infection can lead to serious health complications, such as pneumonia and bronchiolitis, especially in young children.

However, investigators cautioned that more research is needed to confirm these results, especially regarding safety and cost-effectiveness. Despite these limitations, this study provided valuable insights into potential preventive strategies for respiratory syncytial virus and can inform clinical decision-making for high-risk infants and children.

Identifying Best Monoclonal Antibiody Treatment to Protect Infants from RSV

Investigators systematically searched several databases for trials that enrolled infants who showed high risk of respiratory syncytial virus infection to receive a monoclonal antibody or a placebo. The search utilized keywords and vocabulary related to monoclonal antibodies, respiratory syncytial virus, and randomized clinical trials to ensure all relevant studies were considered.

The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used to guide data extraction and synthesis, with 2 investigators working independently to review literature, extract data, and evaluate the risk of bias. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was employed to rate the certainty of evidence.

Investigators conducted a random-effects model network meta-analysis using a consistency model under the frequentist framework. The main outcomes of interest in this study were all-cause mortality, respiratory syncytial virus-related hospitalization, respiratory syncytial virus-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use.

It was concluded that monoclonal antibodies such as motavizumab, nirsevimab, and palivizumab had significant benefits in preventing RSV infection, with no significant increase in adverse events, but further research is needed to validate these findings, particularly with regard to safety and cost-effectiveness.

“Motavizumab was associated with a larger reduction of infection than was palivizumab,” they wrote. “With regard to the rate of RSV-related hospitalization and RSV infection, we did not find significant subgroup differences between patients with and without comorbidities.”

References:

1. Sun M, Lai H, Na F, et al. Monoclonal Antibody for the Prevention of Respiratory Syncytial Virus in Infants and Children: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2023;6(2):e230023. doi:10.1001/jamanetworkopen.2023.0023