Immunoglobulin treatment for respiratory syncytial virus infection

H Fuller, C Del Mar

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although systematic reviews find it of no benefit. Passive protection against RSV can be achieved through monthly intramuscular injection of the humanized monoclonal anti-RSV antibody palivizumab (Synagis), and yields a 55% reduction in RSV hospitalisation in susceptible infants. This review assesses immunoglobulin treatment of RSV infection rather than its role as a prophylactic measure.

OBJECTIVES: To assess the efficacy of adding human or humanized immunoglobulin therapy to supportive therapy in infants hospitalized with laboratory-determined RSV infection.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to Week 4, January 2006) and EMBASE (1980 to September 2005). We also ran searches of reference lists of relevant trials and review articles and searches of personal files. We did not impose any language restrictions.

SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared immunoglobulin treatment with a placebo control in children hospitalized for RSV infection with bronchiolitis or pneumonia or other lower respiratory tract infection (LRTI) with laboratory-documented RSV infection. The primary outcomes of interest were mortality, length of hospitalisation, length of ventilation and oxygen dependence. Secondary outcome measures were pulmonary function and re-hospitalisations for recurrent breathing difficulties in subsequent years. Any adverse effects of the treatments were also noted, for example, hypersensitivity reactions.

DATA COLLECTION AND ANALYSIS: Data were extracted but cross-comparison was not possible due to the shortage of studies and lack comparative measurements.

MAIN RESULTS: Four papers fitted the search criteria. None demonstrated statistically significant benefit of intravenous immunoglobulin (IVIG) treatment added to supportive care compared with supportive care alone. The evidence does not support a role for RSVIG in such a setting, with the doses used in the studies.

AUTHORS' CONCLUSIONS: The evidence on the role of respiratory syncytial virus immunoglobulin (RSVIG) in treating RSV severe infections is limited. Future research might consider using stronger titres of neutralising antibodies; and further analyse severely ill children (who might respond differentially compared to those less ill, but yet hospitalised).

Original languageEnglish
Article numberCD004883
Pages (from-to)1-13
Number of pages13
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 2006

Fingerprint

Respiratory Syncytial Virus Infections
Respiratory Syncytial Viruses
Immunoglobulins
Bronchiolitis
Hospitalization
Therapeutics
Pneumonia
Oxygen
Hospitalized Child
Passive Immunization
Ribavirin
Intravenous Immunoglobulins
Intramuscular Injections
Neutralizing Antibodies
Artificial Respiration
MEDLINE
Respiratory Tract Infections
Libraries
Antiviral Agents
Ventilation

Cite this

@article{f1c711ef17cc4ad6b60d10d577976abd,
title = "Immunoglobulin treatment for respiratory syncytial virus infection",
abstract = "BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although systematic reviews find it of no benefit. Passive protection against RSV can be achieved through monthly intramuscular injection of the humanized monoclonal anti-RSV antibody palivizumab (Synagis), and yields a 55{\%} reduction in RSV hospitalisation in susceptible infants. This review assesses immunoglobulin treatment of RSV infection rather than its role as a prophylactic measure.OBJECTIVES: To assess the efficacy of adding human or humanized immunoglobulin therapy to supportive therapy in infants hospitalized with laboratory-determined RSV infection.SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to Week 4, January 2006) and EMBASE (1980 to September 2005). We also ran searches of reference lists of relevant trials and review articles and searches of personal files. We did not impose any language restrictions.SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared immunoglobulin treatment with a placebo control in children hospitalized for RSV infection with bronchiolitis or pneumonia or other lower respiratory tract infection (LRTI) with laboratory-documented RSV infection. The primary outcomes of interest were mortality, length of hospitalisation, length of ventilation and oxygen dependence. Secondary outcome measures were pulmonary function and re-hospitalisations for recurrent breathing difficulties in subsequent years. Any adverse effects of the treatments were also noted, for example, hypersensitivity reactions.DATA COLLECTION AND ANALYSIS: Data were extracted but cross-comparison was not possible due to the shortage of studies and lack comparative measurements.MAIN RESULTS: Four papers fitted the search criteria. None demonstrated statistically significant benefit of intravenous immunoglobulin (IVIG) treatment added to supportive care compared with supportive care alone. The evidence does not support a role for RSVIG in such a setting, with the doses used in the studies.AUTHORS' CONCLUSIONS: The evidence on the role of respiratory syncytial virus immunoglobulin (RSVIG) in treating RSV severe infections is limited. Future research might consider using stronger titres of neutralising antibodies; and further analyse severely ill children (who might respond differentially compared to those less ill, but yet hospitalised).",
author = "H Fuller and {Del Mar}, C",
year = "2006",
doi = "10.1002/14651858.CD004883.pub2",
language = "English",
pages = "1--13",
journal = "Cochrane database of systematic reviews (Online)",
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number = "4",

}

Immunoglobulin treatment for respiratory syncytial virus infection. / Fuller, H; Del Mar, C.

In: Cochrane Database of Systematic Reviews, No. 4, CD004883, 2006, p. 1-13.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Immunoglobulin treatment for respiratory syncytial virus infection

AU - Fuller, H

AU - Del Mar, C

PY - 2006

Y1 - 2006

N2 - BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although systematic reviews find it of no benefit. Passive protection against RSV can be achieved through monthly intramuscular injection of the humanized monoclonal anti-RSV antibody palivizumab (Synagis), and yields a 55% reduction in RSV hospitalisation in susceptible infants. This review assesses immunoglobulin treatment of RSV infection rather than its role as a prophylactic measure.OBJECTIVES: To assess the efficacy of adding human or humanized immunoglobulin therapy to supportive therapy in infants hospitalized with laboratory-determined RSV infection.SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to Week 4, January 2006) and EMBASE (1980 to September 2005). We also ran searches of reference lists of relevant trials and review articles and searches of personal files. We did not impose any language restrictions.SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared immunoglobulin treatment with a placebo control in children hospitalized for RSV infection with bronchiolitis or pneumonia or other lower respiratory tract infection (LRTI) with laboratory-documented RSV infection. The primary outcomes of interest were mortality, length of hospitalisation, length of ventilation and oxygen dependence. Secondary outcome measures were pulmonary function and re-hospitalisations for recurrent breathing difficulties in subsequent years. Any adverse effects of the treatments were also noted, for example, hypersensitivity reactions.DATA COLLECTION AND ANALYSIS: Data were extracted but cross-comparison was not possible due to the shortage of studies and lack comparative measurements.MAIN RESULTS: Four papers fitted the search criteria. None demonstrated statistically significant benefit of intravenous immunoglobulin (IVIG) treatment added to supportive care compared with supportive care alone. The evidence does not support a role for RSVIG in such a setting, with the doses used in the studies.AUTHORS' CONCLUSIONS: The evidence on the role of respiratory syncytial virus immunoglobulin (RSVIG) in treating RSV severe infections is limited. Future research might consider using stronger titres of neutralising antibodies; and further analyse severely ill children (who might respond differentially compared to those less ill, but yet hospitalised).

AB - BACKGROUND: Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalize hundreds of thousands of infants every year. Treatment is largely supportive therapy, (for example, oxygen, fluids and occasionally mechanical ventilation). Ribavirin, an antiviral agent, is licensed for severe RSV infection, although systematic reviews find it of no benefit. Passive protection against RSV can be achieved through monthly intramuscular injection of the humanized monoclonal anti-RSV antibody palivizumab (Synagis), and yields a 55% reduction in RSV hospitalisation in susceptible infants. This review assesses immunoglobulin treatment of RSV infection rather than its role as a prophylactic measure.OBJECTIVES: To assess the efficacy of adding human or humanized immunoglobulin therapy to supportive therapy in infants hospitalized with laboratory-determined RSV infection.SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2006), MEDLINE (1966 to Week 4, January 2006) and EMBASE (1980 to September 2005). We also ran searches of reference lists of relevant trials and review articles and searches of personal files. We did not impose any language restrictions.SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared immunoglobulin treatment with a placebo control in children hospitalized for RSV infection with bronchiolitis or pneumonia or other lower respiratory tract infection (LRTI) with laboratory-documented RSV infection. The primary outcomes of interest were mortality, length of hospitalisation, length of ventilation and oxygen dependence. Secondary outcome measures were pulmonary function and re-hospitalisations for recurrent breathing difficulties in subsequent years. Any adverse effects of the treatments were also noted, for example, hypersensitivity reactions.DATA COLLECTION AND ANALYSIS: Data were extracted but cross-comparison was not possible due to the shortage of studies and lack comparative measurements.MAIN RESULTS: Four papers fitted the search criteria. None demonstrated statistically significant benefit of intravenous immunoglobulin (IVIG) treatment added to supportive care compared with supportive care alone. The evidence does not support a role for RSVIG in such a setting, with the doses used in the studies.AUTHORS' CONCLUSIONS: The evidence on the role of respiratory syncytial virus immunoglobulin (RSVIG) in treating RSV severe infections is limited. Future research might consider using stronger titres of neutralising antibodies; and further analyse severely ill children (who might respond differentially compared to those less ill, but yet hospitalised).

U2 - 10.1002/14651858.CD004883.pub2

DO - 10.1002/14651858.CD004883.pub2

M3 - Article

SP - 1

EP - 13

JO - Cochrane database of systematic reviews (Online)

JF - Cochrane database of systematic reviews (Online)

SN - 1469-493X

IS - 4

M1 - CD004883

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