Improving the prescribing of palivizumab

Trist, Simone; Horsley, Emily; Katf, Hala; Tasker, Natalie; Mostaghim, Mona

doi:10.1111/jpc.14083

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…We present here real-world data on the use of palivizumab in a high-risk cohort of infants in Western Australia. More than 90 % of infants receiving palivizumab had at least one high-risk condition for palivizumab use; a study conducted in New South Wales reported only 67.5% of infants administered palivizumab met their local hospital guidelines [20]. We also found that gestational age < 28 weeks, CHD and being born after 2010…”

Section: Discussionmentioning

confidence: 50%

RSV prophylaxis use in high-risk infants in Western Australia, 2002-2013: a record linkage cohort study

Fathima

Strunk

et al. 2020

BMC Pediatr

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Background The monoclonal antibody, palivizumab is licensed for use in high-risk infants to prevent severe illness caused by respiratory syncytial virus (RSV). The level of its use and compliance with current jurisdictional guidelines which were amended in 2010, is unknown. We determined the level of palivizumab use in a cohort of high-risk infants in Western Australia. Methods Using probabilistically linked administrative data, we conducted a birth cohort study within tertiary neonatal intensive care units (NICUs) born between 2002 and 2013. We described palivizumab use by patient characteristics, eligibility criteria according to guidelines over the period of study and identified predictors of its use. Results Of 24,329 infants admitted to tertiary NICUs, 271 (1.1%) were dispensed 744 palivizumab doses with 62.5% being dispensed to infants born 2010–2013. The median number of doses received was 2. A total of 2679 infants met at least one of three criteria for palivizumab (criteria 1: gestational age at birth < 28 weeks and chronic lung disease; criteria 2: gestational age < 28 weeks and Aboriginal; criteria 3: congenital heart disease not otherwise in criteria 1 or 2). The extent of palivizumab use differed across the 3 groups. Of 803 infants meeting criteria 1, 21.8% received at least 1 dose of palivizumab; 52.8% from 2010 onwards. From 174 infants meeting criteria 2, 14.4% received at least 1 dose; 43.1% from 2010 onwards and from 1804 births meeting criteria 3, only 3.7% received at least 1 dose; 5.4% from year of birth 2010 onwards). In adjusted analyses, being born after 2010, being extreme preterm, chronic lung disease, congenital lung disease and being born in autumn or winter were independent predictors of palivizumab use. Conclusion In this high-risk setting and notwithstanding the limitations of our data sources, the level of compliance of palivizumab use against current guidelines was low. Most doses were dispensed to infants meeting at least one high-risk criterion. Evidence of incomplete dosing is an important finding in light of recent developments of single dose monoclonal antibodies offering longer protection.

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Section: Discussionmentioning

confidence: 50%

RSV prophylaxis use in high-risk infants in Western Australia, 2002-2013: a record linkage cohort study

Fathima

Strunk

et al. 2020

BMC Pediatr

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“…The F protein is therefore less shielded compared to the G protein and constitutes a more suitable therapeutic target [43]. A concern regarding the increased use of palivizumab is the emergence of antibody-resistant viruses [45]. Clinical isolates with N262D, K272E/M/Q and S275F/L substitutions in the palivizumab-binding site (antigenic site II, amino acids 258–275) exhibited resistance to neutralization by palivizumab [17].…”

Section: Discussionmentioning

confidence: 99%

Detection of ON1 and novel genotypes of human respiratory syncytial virus and emergence of palivizumab resistance in Lebanon

et al. 2019

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Respiratory syncytial virus (RSV) is a common cause of respiratory tract infections in children and immunocompromised individuals. A multi-center surveillance of the epidemiologic and molecular characteristics of RSV circulating in Lebanon was performed. The attachment (G) and fusion (F) glycoproteins were analyzed and compared to those reported regionally and globally. 16% (83/519) of the nasopharyngeal swabs collected during the 2016/17 season tested positive for RSV; 50% (27/54) were RSV-A and 50% (27/54) were RSV-B. Phylogenetic analysis of the G glycoprotein revealed predominance of the RSVA ON1 genotype, in addition to two novel Lebanese genotype variants, hereby named LBA1 and LBA2, which descended from the ON1 and NA2 RSV-A genotypes, respectively. RSV-B strains belonged to BA9 genotype except for one BA10. Deduced amino acid sequences depicted several unique substitutions, alteration of glycosylation patterns and the emergence of palivizumab resistance among the Lebanese viruses. The emergence of ON1 and other novel genotypes that are resistant to palivizumab highlights the importance of monitoring RSV globally.

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“…20,24 In our study, no child received palivizumab prophylaxis. This finding is not unexpected; low prescribing has been described in this setting 25 and is likely related to high cost, unclear cost-effectiveness, a lack of Australian guidelines, and the requirement for monthly intramuscular injections. 21,[25][26][27][28] Single-dose mAb and RSV vaccines are in active development 27,29,30 and might play a role in the prevention of RSV-attributable deaths in the future; however, the evidence for this will need to be established.…”

Section: Discussionmentioning

confidence: 73%

Respiratory Syncytial Virus-attributable Deaths in a Major Pediatric Hospital in New South Wales, Australia, 1998–2018

Saravanos

Hsu

Isaacs

et al. 2021

Pediatric Infectious Disease Journal

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Background: Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infection and an important contributor to child mortality. In this study, we estimated the frequency and described the clinical features of RSV-attributable deaths in Australian children. Methods:We conducted a retrospective observational study of RSV-associated deaths in hospitalized children <16 years of age over a 21-year period in a pediatric tertiary/quaternary referral hospital in New South Wales (NSW), Australia. RSV-associated deaths were identified, reviewed, and classified according to RSV contribution to death. For 'RSV-attributable' deaths, we estimated frequency, case fatality ratio (CFR), and population death rate. We described demographic and clinical features of cases. Results: There were 20 RSV-attributable deaths. RSV was considered the primary cause of death for five cases and a contributory cause for 15 cases. The CFR among hospitalized cases was 0.2% (20/9779). The annual death rate was 0.6 per 10,000 hospitalized children. The population death rate was 1.2 (95% confidence interval 0.5-2.7) per million children <16 years of age in NSW. The median age at death was 28.7 months (interquartile range 8.8-75.0). All children had at least one medical comorbidity. Over half the deaths occurred in children ≥2 years of age (11, 55%). RSV healthcareassociated infection (RSV-HAI) was common (11, 55%). Conclusions: RSV-attributable death is infrequent in this setting. Deaths occurred exclusively in children with medical comorbidity and a high proportion were RSV-HAI. Children with medical comorbidity, including those ≥2 years of age, should be prioritized for targeted prevention of RSV disease.

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Improving the prescribing of palivizumab

Cited by 7 publications

References 12 publications

RSV prophylaxis use in high-risk infants in Western Australia, 2002-2013: a record linkage cohort study

RSV prophylaxis use in high-risk infants in Western Australia, 2002-2013: a record linkage cohort study

Detection of ON1 and novel genotypes of human respiratory syncytial virus and emergence of palivizumab resistance in Lebanon

Respiratory Syncytial Virus-attributable Deaths in a Major Pediatric Hospital in New South Wales, Australia, 1998–2018

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