Introduction
Methods
Literature Search
Study Selection
Data Analyses
Statement of Ethics Compliance
Results
Efficacy: Reduction of RSV-Related Hospitalization
Efficacy of Palivizumab in Randomized, Placebo-Controlled Clinical Trials
Population | Study | Study drug | RSV-associated hospitalization | RSV ICU admission | Mechanical ventilation | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Incidence, n/N (%) | Relative reduction rate vs. placebo, % (95% CI) |
P value vs. placebo | Total days/100 subjects | Days with increased supplemental oxygen | % Subjects | Total days | % Subjects | Total days | |||
BPD/CLDP or prematurity | Subramanian et al. [29] | Placebo | 2/20 (10.0) | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 0/22 (0) | 100 | NA | NA | NA | NA | NA | NA | NA | ||
IMpact-RSV [24] | Placebo | 53/500 (10.6) | 62.6 | 50.6 | 3.0 | 12.7 | 0.2 | 1.7 | |||
Palivizumab | 48/1,002 (4.8) | 55 (38, 72) | <0.001 | 36.4 (P < 0.001) | 30.3 (P < 0.001) | 1.3 (P = 0.026) | 13.3 (P = 0.023) | 0.7 | 8.4 | ||
Carbonell-Estrany et al. [70] | Palivizumab | 62/3,306 (1.9) | 18.1 | 9.5/100 subjects | 0.6 | 6.3/100 subjects | 0.3 | 3.8/100 subjects | |||
Motavizumab | 46/3,329 (1.4) | 9.1 | 4.1/100 subjects | 0.3 | 2.0/100 subjects | 0.1 | 0.5/100 subjects | ||||
BPD/CLDP | IMpact-RSV [24] | Placebo | 34/266 (12.8) | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 39/496 (7.9) | 39 (20, 58) | 0.038 | NA | NA | NA | NA | NA | NA | ||
Carbonell-Estrany et al. [70] | Palivizumab | 28/723 (3.9) | NA | NA | NA | NA | NA | NA | |||
Motavizumab | 22/722 (3.0) | NA | NA | NA | NA | NA | NA | ||||
Prematurity (all) | Carbonell-Estrany et al. [70] | Palivizumab | 34/2,583 (1.3) | NA | NA | NA | NA | NA | NA | ||
Motavizumab | 24/2,607 (0.9) | NA | NA | NA | NA | NA | NA | ||||
≤32 weeks GA | Carbonell-Estrany et al. [70] | Palivizumab | 19/1,265 (1.5) | NA | NA | NA | NA | NA | NA | ||
Motavizumab | 13/1,306 (1.0) | NA | NA | NA | NA | NA | NA | ||||
Tavsu et al. [31] | No prophylaxis | Prophylaxis year: 10/41 (24.4) Following year: 10/41 (24.4) | NA | NA | NA | NA | NA | NA | |||
Palivizumab | Prophylaxis year: 0/39 (0) Following year: 0/39 (0) | 100 | 0.001 | NA | NA | NA | NA | NA | NA | ||
33–35 weeks GA | Carbonell-Estrany et al. [70] | Palivizumab | 15/1,318 (1.1) | NA | NA | NA | NA | NA | NA | ||
Motavizumab | 11/1,301 (0.8) | NA | NA | NA | NA | NA | NA | ||||
MAKI [30] | Placebo | 11/215 (5.1) | NA | NA | NA | NA | NA | NA | |||
Palivizumab | 2/214 (0.9) | 82 (18, 157) | 0.01 | NA | NA | NA | NA | NA | NA | ||
≤35 weeks GA | IMpact-RSV [24] | Placebo | 19/234 (8.1) | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 9/506 (1.8) | 78 (66, 90) | <0.001 | NA | NA | NA | NA | NA | NA | ||
CHD (all) | Cardiac [23] | Placebo | 63/648 (9.7) | 129.0 | 658 | 3.7 | 461 | 2.2 | 354 | ||
Palivizumab | 34/639 (5.3) | 45 (23, 67) | 0.003 | 57.4 (P = 0.003) | 178 (P = 0.014) | 2.0 | 101 | 1.3 | 42 | ||
Feltes et al. [71] | Palivizumab | 16/612 (2.6) | 18.9 | 19.8 | 1.0 | 27.5 | 0.7 | 28.5 | |||
Motavizumab | 12/623 (1.9) | 12.7 | 8.5 | 0.8 | 7.0 | 0.3 | 8.0 | ||||
Cyanotic | Cardiac [23] | Placebo | 7.9 | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 5.6 | 29 | 0.285 | NA | NA | NA | NA | NA | NA | ||
Feltes et al. [71] | Palivizumab | 7/319 (2.2) | NA | NA | NA | NA | NA | NA | |||
Motavizumab | 7/346 (2.0) | NA | NA | NA | NA | NA | NA | ||||
Acyanotic | Cardiac [23] | Placebo | 11.8 | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 5.0 | 58 | 0.003 | NA | NA | NA | NA | NA | NA | ||
Feltes et al. [71] | Palivizumab | 9/293 (3.1) | NA | NA | NA | NA | NA | NA | |||
Motavizumab | 5/277 (1.8) | NA | NA | NA | NA | NA | NA | ||||
Age <6 months | Cardiac [23] | Placebo | 12.2 | NA | NA | NA | NA | NA | NA | ||
Palivizumab | 6.0 | 51 | NA | NA | NA | NA | NA | NA | NA | ||
6–12 months | Placebo | 7.3 | NA | NA | NA | NA | NA | NA | |||
Palivizumab | 6.1 | 16 | NA | NA | NA | NA | NA | NA | NA | ||
1–2 years | Placebo | 4.3 | NA | NA | NA | NA | NA | NA | |||
Palivizumab | 1.8 | 58 | NA | NA | NA | NA | NA | NA | NA |
Efficacy of Palivizumab in Prospective, Open-Label, Non-Comparative Clinical Trials
Population | Study | RSV-associated hospitalization | RSV ICU admission | Mechanical ventilation | ||
---|---|---|---|---|---|---|
Incidence, n/N(%) | Total days/100 subjects | Days with increased supplemental oxygen | % Subjects | % Subjects | ||
BPD/CLDP, prematurity, or CHD | Turti et al. [40] | 0/100 (0) | NA | NA | NA | NA |
BPD/CLDP or prematurity | Expanded Access [32] | 12/565 (2.1) | NA | NA | NA | NA |
BPD/CLDP | Lacaze-Masmonteil et al. [38] | First-season exposure: 1/71 (1.4) | NA | NA | NA | NA |
Second-season exposure: 4/63 (6.3) | ||||||
Prematurity | ||||||
29–32 weeks GA | PROTECT [39] | 5/285 (1.8) | 17.6 | Median 7.5 (range 6.0–9.0) | 0.7 | 0.7 |
≤35 weeks GA | Lacaze-Masmonteil et al. [38] | 5/134 (3.7) | NA | NA | NA | NA |
RSV-Related Hospitalizations in Prospective Observational Studies/Registries
Population | Study | RSV-associated hospitalization | RSV ICU admission | Mechanical ventilation | ||||
---|---|---|---|---|---|---|---|---|
Incidence, % of N
| Total days, mean ± SD | Days with increased supplemental oxygen, mean ± SD | % Subjects | Total days, mean ± SD | % Subjects | Total days, mean ± SD | ||
BPD/CLDP or prematurity | Pedraz et al. [45] | Nonprophylaxed: 13.25 of 1,583 | Median (IQR), 8 (5, 11) | NA | 2.1 | NA | 0.8 | NA |
Palivizumab: 3.95 of 1,919 | Median (IQR), 6 (4, 9) (P < 0.01) | 0.5 | 0.4 | |||||
BPD/CLDP | Pedraz et al. [45] | Nonprophylaxed: 19.7 of 71 | NA | NA | NA | NA | NA | NA |
Palivizumab: 5.5 of 217 (P < 0.007) | ||||||||
French ATU Program [42] | 9.0 of 400 | NA | NA | NA | NA | NA | NA | |
Palivizumab Outcomes Registry [41] | 2.40 of 4,329 | NA | NA | NA | NA | NA | NA | |
CARESS (2005–2009)a [26] | 1.31b of 449 | NA | NA | NA | NA | NA | NA | |
Prematurity | ||||||||
≤28 weeks GA | Pedraz et al. [45] | Nonprophylaxed: 13.0 of 246 | NA | NA | NA | NA | NA | NA |
Palivizumab: 5.4 of 739 (P < 0.0001) | ||||||||
French ATU Program [42] | 5.8 of 258 | NA | NA | NA | NA | NA | NA | |
CARESS (2005–2009)c [26] | 1.34b of 1,704 | NA | NA | NA | NA | NA | NA | |
29–32 weeks GA | Pedraz et al. [45] | Nonprophylaxed: 9.9 of 1,297 | NA | NA | NA | NA | NA | NA |
Palivizumab: 2.5 of 1,170 (P < 0.0000) | ||||||||
French ATU Program [42] | 10.4 of 182 | NA | NA | NA | NA | NA | NA | |
CARESS (2005–2009)a [26] | 1.25b of 1,449 | NA | NA | NA | NA | NA | NA | |
<32 weeks GA | Palivizumab Outcomes Registry [41] | 1.84 of 7,786 | NA | NA | NA | NA | NA | NA |
≤32 weeks GA | Canadian Special Access Programme [44] | 1.6b of 324 | NA | NA | NA | NA | NA | NA |
CARESS (2006–2011)a [28] | 1.5b of 5,183 | 6.7 ± 5.4 | 0.5 ± 2.2 | 0.3 | 1.2 ± 2.7 | 0.3 | 1.3 ± 2.9 | |
32–35 weeks GA | Palivizumab Outcomes Registry [41] | 0.83 of 9,294 | NA | NA | NA | NA | NA | NA |
33–35 weeks GA | CARESS (2005–2009)a [26] | 0.2b of 588 | NA | NA | NA | NA | NA | NA |
CARESS (2006–2011)a [28] | 1.4b of 1,471 | 5.2 ± 5.0 | 0.2 ± 0.9 | 0.3 | 1.3 ± 2.4 | 0.3 | 0.3 ± 1.8 | |
<35 weeks GA | Lesnick et al. [43] | 1.0 of 2,838 | NA | NA | NA | NA | NA | NA |
≤35 weeks GA | CARESS (2005–2009)a [26] | 1.12b of 3,741 | NA | NA | NA | NA | NA | NA |
CARESS (2006–2010)a [27] | 1.3b of 4,880 | 7.3 ± 6.9 | 0.7 ± 2.9 | 0.3 | 1.7 ± 3.7 | 0.2 | 1.0 ± 3.1 | |
CHD | Palivizumab Outcomes Registry [41] | 1.88 of 1,490 | NA | NA | NA | NA | NA | NA |
CARESS (2005–2009)a [26] | 1.99b of 508 | NA | NA | NA | NA | NA | NA | |
All prescribed | French ATU Program [42] | 7.6c of 516 | NA | NA | 1.9 | NA | 0.8 | NA |
Canadian Special Access Programme [44] | 2.4b of 444 evaluable | 5.5 ± 3.8 | NA | NA | NA | NA | NA | |
Lesnick et al. [43] | 0.8 of 3,520 | NA | NA | NA | NA | NA | NA | |
Golombek et al. [72] | 1.17 of 1,446 overall (3.57 of 224 physician’s office setting; 0.93 of 969 home setting) | NA | NA | NA | NA | NA | NA | |
Palivizumab Outcomes Registry [41] | 1.3 of 19,474d evaluable | NA | NA | NA | NA | NA | NA | |
German Palivizumab Registry [46] | 1.6c of 9,833 evaluable | NA | NAc
| 0.5 | NA | 0.1 | NA | |
CARESS (2005–2009)d [26] | 1.38b of 5,286 | 8.0 ± 6.8 | 0.9 ± 3.1 | NA | 2.4 ± 4.5 | NA | 2.0 ± 4.1 | |
Congenital airway abnormality/severe neuromuscular disease | Palivizumab Outcomes Registry [41] | 2.14 of 1,122 | NA | NA | NA | NA | NA | NA |
>35 weeks GA and non-BPD/CHD medical disorders | CARESS (2006–2010)a [27] | 2.4b of 952 | 7.3 ± 5.8 | 1.6 ± 3.6 | 0.8 | 3.3 ± 5.4 | 1.3 | 3.6 ± 5.0 |
>35 weeks GA | Palivizumab Outcomes Registry [41] | 1.13 of 2,390 | NA | NA | NA | NA | NA | NA |
Other | CARESS (2005–2009)a [26] | 2.78b of 592 | NA | NA | NA | NA | NA | NA |
Secondary Outcomes: RSV Hospitalization-Related Endpoints
Safety and Immunogenicity
Population | Study | Study drug dose | Subjects with ≥1 at least possibly related, % | Most commonly reported AEs, % | Commonly reported SAEs, % | Injection site reaction, % | AEs leading to D/C, % | Deaths, % | |
---|---|---|---|---|---|---|---|---|---|
AE | SAE | ||||||||
BPD/CLDP, prematurity, or CHD | Expanded Access [32] | Palivizumab (n = 565) | 6.9 | NA | Fever 1.5%, diarrhea 0.8%, nervousness/irritability 0.8%a
| NA | 2.3a
| 1.9 | 0.4 |
Lacaze-Masmonteil et al. [38] | Palivizumab, season 1 (n = 71) | NA | 0 | Infection, injection site reaction, diarrhea 1.4% eacha
| Bronchiolitis 5.6%, BPD aggravation 2.8%, vomiting 2.8% | 1.4a
| 0 | 0 | |
Palivizumab, season 2 (n = 63) | NA | 0 | Fever 3.2%; anorexia, epistaxis, ataxia 1.6% eacha
| Bronchiolitis 4.8%, fever 3.2% | 0a
| 0 | 0 | ||
Turti et al. [40] | Palivizumab (n = 100) | 2.0 | 0 | Rhinitis, dermatitis 1.0% each | NA | NA | 1.0 | 0 | |
BPD/CLDP or prematurity | Subramanian et al. [29] | Placebo (n = 20) | 15.0 | NA | NA | NA | NA | 0 | 5.0 |
Palivizumab 15 mg/kg (n = 22) | 23.0 | NA | NA | NA | NA | 0 | 0 | ||
IMpact-RSV [24] | Placebo (n = 500) | 10.0 | NA | Fever 3.0%, nervousness 2.6%, injection site reaction 1.6%a
| NA | 1.8 | NA | 1.0 | |
Palivizumab 15 mg/kg (n = 1,002) | 11.0 | NA | Fever 2.8%, nervousness 2.5%, injection site reaction 2.3%a
| NA | 2.7 | 0.3 | 0.4 | ||
Carbonell-Estrany et al. [70] | Palivizumab 15 mg/kg (n = 3,298) | NA | NA | URTI 30.1%, pyrexia 16.9%, rhinitis 13.5%, otitis media 12.8%, bronchiolitis 9.9%, teething 8.6%, diarrhea 8.5%, respiratory disorder 8.4%, nasal congestion 8.0%, conjunctivitis 7.6%, gastroenteritis 7.1%, bronchitis 6.9%, constipation 6.9%, cough 6.5%, gastroesophageal reflux disease 6.3%, diaper dermatitis 5.8%, vomiting 5.2%, irritability 5.0% | NA | 2.7 | 0.3 | 0.1 | |
Prematurity | MAKI [30] | Placebo (n = 215) | NA | NA | NA | NA | NA | NA | 0 |
Palivizumab 15 mg/kg (n = 214) | NA | NA | NA | NA | NA | NA | 0 | ||
CHD | Cardiac [23] | Placebo (n = 648) | 6.9 | 0.5 | URTI 46.1%, fever 23.9%, conjunctivitis 9.3%, cyanosis 6.9%, infection 2.9%, arrhythmia 1.7% | Arrhythmia 0.3%, cyanosis 2.2% | 2.2 | 0a
| 4.2 |
Palivizumab 15 mg/kg (n = 639) | 7.2 | 0 | URTI 47.4%, fever 27.1%, conjunctivitis 11.3%, cyanosis 9.1%, infection 5.6%, arrhythmia 3.1% | Arrhythmia 0.2%, cyanosis 3.6% | 3.4 | 0a
| 3.3 | ||
Feltes et al. [71] | Palivizumab 15 mg/kg (n = 612) | 8.8 | 1.0 | Pyrexia 29.2%, URTI 28.1%, rhinitis 12.6%, cough 11.6%, otitis media 11.4%, gastroenteritis 10.8%, diarrhea 10.6%, nasopharyngitis 9.5%, vomiting 8.3%, Tetralogy of Fallot 8.2%, bronchitis 7.8%, rhinorrhea 7.4%, ventricular septal defect 6.2%, teething 5.9%, pneumonia 5.9%, blood urea increased 5.6%, nasal congestion 5.4%, constipation 5.1%, viral infection 5.1%, dermatitis diaper 5.1% | Tetralogy of Fallot 8.0%, ventricular septal defect 5.9%, pneumonia 3.8%, atrioventricular septal defect 3.6% | NA | 0.2 | 1.6 |
Population | Study | Study drug dose | Subjects with ≥1 at least possibly related, % | Most commonly reported AEs, % | Commonly reported SAEs, % | Injection site reaction, % | AEs leading to D/C, % | Deaths, % | |
---|---|---|---|---|---|---|---|---|---|
AE | SAE | ||||||||
BPD/CLDP, prematurity, or CHD | Expanded Access [32] | Palivizumab (n = 565) | 6.9 | NA | Fever 1.5%, diarrhea 0.8%, nervousness/irritability 0.8%a
| NA | 2.3a
| 1.9 | 0.4 |
Lacaze-Masmonteil et al. [38] | Palivizumab, season 1 (n = 71) | NA | 0 | Infection, injection site reaction, diarrhea 1.4% eacha
| Bronchiolitis 5.6%, BPD aggravation 2.8%, vomiting 2.8% | 1.4a
| 0 | 0 | |
Palivizumab, season 2 (n = 63) | NA | 0 | Fever 3.2%; anorexia, epistaxis, ataxia 1.6% eacha
| Bronchiolitis 4.8%, fever 3.2% | 0a
| 0 | 0 | ||
Turti et al. [40] | Palivizumab (n = 100) | 2.0 | 0 | Rhinitis, dermatitis 1.0% each | NA | NA | 1.0 | 0 | |
Prematurity | PROTECT [39] | Palivizumab (n = 285) | NA | NA | Fever, infection, enteritis, bronchiolitis, bronchitis, increased cough, pneumonia, rhinitis, conjunctivitis 0.4% eacha
| RSV infection, RSV bronchiolitis, pneumonia, conjunctivitis 0.4% eacha
| NA | 0.7 | 0 |