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Review
. 2018 Mar;7(1):87-120.
doi: 10.1007/s40121-018-0188-z. Epub 2018 Feb 22.

Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children

Eric A F Simões  1 , Louis Bont  2   3 , Paolo Manzoni  3   4 , Brigitte Fauroux  5 , Bosco Paes  6 , Josep Figueras-Aloy  7 , Paul A Checchia  8 , Xavier Carbonell-Estrany  9
Affiliations
Review

Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children

Eric A F Simões et al. Infect Dis Ther. 2018 Mar.

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 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 < 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.

Keywords: Antibody; Antiviral; IGIV; Motavizumab; Palivizumab; Prophylaxis; Respiratory syncytial virus; Ribavirin; Special populations; Vaccine.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram. Treatment and prevention strategies for RSV over the last 20 years. RSV respiratory syncytial virus. References were screened for inclusion in two Phases. Phase I screening was split into two Stages, Stage 1—based on title and, for those meeting the inclusion criteria, Stage 2—based on abstract. Those references retained after Phase 1 were assessed based on the full paper in Phase 2
Fig. 2
Fig. 2
A snapshot of vaccines to prevent RSVH in preclinical and clinical development worldwide. Adapted from the PATH (formerly the Program for Appropriate Technology in Health) [143]
Fig. 3
Fig. 3
A snapshot of monoclonal antibodies to prevent RSVH in preclinical and clinical development worldwide. Adapted from the PATH (formerly the Program for Appropriate Technology in Health) [143]
See this image and copyright information in PMC

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