Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children
Simões, Eric A.F.; Bont, Louis; Manzoni, Paolo; Fauroux, Brigitte; Paes, Bosco; Figueras-Aloy, Josep; Checchia, Paul A.; Carbonell-Estrany, Xavier
(2018) Infectious Diseases and Therapy, volume 7, issue 1, pp. 87 - 120
(Article)
Abstract
Introduction: The REGAL (RSV Evidence – A Geographical Archive of the Literature) series has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This seventh and final publication covers the past, present and future approaches to
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the prevention and treatment of RSV infection among infants and children. Methods: A systematic review was undertaken of publications between January 1, 1995 and December 31, 2017 across PubMed, Embase and The Cochrane Library. Studies reporting data on the effectiveness and tolerability of prophylactic and therapeutic agents for RSV infection were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. A further nonsystematic search of the published literature and Clinicaltrials.gov on antiviral therapies and RSV vaccines currently in development was also undertaken. Results: The systematic review identified 1441 studies of which 161 were included. Management of RSV remains centered around prophylaxis with the monoclonal antibody palivizumab, which has proven effective in reducing RSV hospitalization (RSVH) in preterm infants OpenSPiltSPi 36 weeks’ gestational age (72% reduction), children with bronchopulmonary dysplasia (65% reduction), and infants with hemodynamically significant congenital heart disease (53% reduction) (high SOE). Palivizumab has also shown to be effective in reducing recurrent wheezing following RSVH (high SOE). Treatment of RSV with ribavirin has conflicting success (moderate SOE). Antibodies with increased potency and extended half-life are currently entering phase 3 trials. There are approximately 15 RSV vaccines in clinical development targeting the infant directly or indirectly via the mother. Conclusion: Palivizumab remains the only product licensed for RSV prophylaxis, and only available for high-risk infants. For the general population, there are several promising vaccines and monoclonal antibodies in various stages of clinical development, with the aim to significantly reduce the global healthcare impact of this common viral infection. Funding: AbbVie.
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Keywords: Antibody, Antiviral, IGIV, Motavizumab, Palivizumab, Prophylaxis, Respiratory syncytial virus, Ribavirin, Special populations, Vaccine, Microbiology (medical), Infectious Diseases
ISSN: 2193-8229
Publisher: Springer Healthcare
Note: Funding Information: Funding. Dr Joanne Smith, Julie Blake (Reviewers 1 and 2) and Dr Barry Rodgers-Gray (Reviewer 3), from Strategen Limited, undertook the systematic review following the protocol approved by the authors. AbbVie provided funding to Strategen to undertake the systematic review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. Editorial assistance in the preparation of this manuscript was provided by Julie Blake and Barry Rodgers-Gray. Julie Blake and Barry Rodgers-Gray developed a first draft of the manuscript, based on the results of the systematic review and input/approval from all authors, which was initially edited by Xavier Carbonell-Estrany and Eric Simões and then circulated among the other authors for input, further edits and subsequent approval. Support for this assistance was funded by AbbVie. AbbVie had the opportunity to review and comment on the completed manuscript but final editorial control rested fully with the authors. AbbVie also funded the article processing charges associated with this article. Funding Information: Disclosures. Louis Bont has regular interaction with pharmaceutical and other industrial partners. He has not received personal fees or other personal benefits. UMCU has received major funding ([€100,000 per industrial partner) for investigator initiated studies from AbbVie, MedImmune, Janssen, the Bill and Melinda Gates Foundation and MeMed Diagnostics. UMCU has received minor funding participation in trials by Regeneron and Janssen since 2015 (total annual estimate less than €20,000). He received minor funding for consultation and invited lectures by AbbVie, MedImmune, Ablynx, Bavaria Nordic, MabXience, Novavax, Janssen (total annual estimate less than €20,000). Paul Checchia has acted as an expert advisor and speaker for Abb-Vie and has received honoraria in this regard. He has also received research grant funding from AstraZeneca. Brigitte Fauroux has received compensation as a neonatology board member from AbbVie. Josep Figueras-Aloy has acted as an expert advisor and speaker for AbbVie and has received honoraria in this regard. Paolo Manzoni has acted as a speaker for AbbVie and as an expert advisor for AbbVie, TEVA, Medim-mune, AstraZeneca, Janssen, and has received honoraria in this regard. Bosco Paes has received research funding from AbbVie Corporation and compensation as an advisor or lecturer from AbbVie and MedImmune. Eric Simões has received grant funding to his institution from Medimmune, Regeneron and Glaxo Smith Kline. Xavier Carbonell-Estrany has acted as an expert advisor and speaker for AbbVie and has received honoraria in this regard. Publisher Copyright: © 2018, The Author(s).
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