Product review on the monoclonal antibody palivizumab for prevention of respiratory syncytial virus infection

Abstract

Respiratory syncytial virus (RSV) accounts for about 20% of all respiratory infections in children below the age of 5 y. It is associated with up to 63% of all acute respiratory infections and up to 81% of all viral lower respiratory tract infections causing hospitalization in infants and young children. RSV leads to seasonal epidemics between November and April in the northern hemisphere. Most severe infections (RSV accounts for 50 to 80% of all cause bronchiolitis) affect infants younger than 6 months of age and high-risk infants including those born preterm with or without bronchopulmonary dysplasia and those with hemodynamically significant congenital heart disease up to an age of 24 months. Palivizumab, a highly potent RSV-neutralizing monoclonal antibody (Mab), has been licensed in 1998 for prophylactic use to prevent RSV associated hospitalizations in high-risk infants. This Mab is given by monthly intramuscular injection at a dose of 15 mg/kg over the RSV season (up to 5 times). Palivizumab proved to be safe and well-tolerated in this population. Concerns have been raised regarding cost-effectiveness of palivizumab and thus, palivizumab prophylaxis is mainly limited to selected high-risk infants for the first RSV season. Long-lasting Mabs will be the next future approach in the prophylaxis of RSV hospitalization until a vaccine is developed.

Exchange Proteins Directly Activated by cAMP and Their Roles in Respiratory Syncytial Virus Infection

“…Overall, there is no vaccine or effective treatment besides supportive measures. Although palivizumab is available for preventing RSV-associated hospitalizations, it is not very cost-effective and is mainly limited to high-risk infants for the first RSV season (7). Here, we identified a new potential role of EPAC molecules in airway epithelial cells in response to RSV infection.…”

“…It is well known that RSV infection enhances the production of several cytokines/chemokines, including IP-10, RANTES, and MIP-1␤, in airway epithelial cells (16,46,47). The expression of these cytokines/chemokines promotes activation and recruitment of immune cells, resulting in increased secretion of inflammatory cytokines/chemokines (7,10). Several reports have shown that excessive host responses induced by inflammatory mediators may be linked to hyperresponsiveness and airway damage during virus clearance (20,44).…”

“…high-risk infants for their first RSV season (7). In addition, there is no specific and effective treatment against RSV, since the host-RSV interaction is still poorly understood.…”

Viruses and non-allergen environmental triggers in asthma

“…Causality between early infection and development of asthma has been hard to prove, but perhaps one of the more convincing pieces of evidence involves palivizumab, an anti-RSV antibody that has been shown to have 70%-80% efficacy in preventing RSV hospitalization. 37 Treated patients were followed up to age 6 years. By that time, there was no significant difference in asthma prevalence between treated and untreated groups; however, there was significantly decreased rate of recurrent wheezing in the cohort.…”

Progress in the development of virus-like particle vaccines against respiratory viruses

“…Thirty-three million cases worldwide in children under at age 5 are estimated to be infected with RSV-associated acute lower respiratory infections and about 10% of patients were being hospitalized, resulted in about 1-3% of in-hospital deaths [8]. Palivizumab, the licensed monoclonal antibody (Ab), has been used as a prophylactic drug to prevent severe RSV disease in high-risk children [9]. Since palivizumab has safety and efficacy concerns such as anaphylaxis and hypersensitivity reactions, palivizumab is not recommended for the therapeutic-treatment post-RSV infection [10].…”