Palivizumab May Not Be Effective Against Severe RSV in Immunocompromised Children

Evidence supporting the use of palivizumab to prevent severe respiratory syncytial virus (RSV) disease in immunocompromised children is insufficient, according to study results published in The Journal of the Pediatric Infectious Diseases Society.

The American Academy of Pediatrics previously recommended that pediatricians consider palivizumab for immunoprophylaxis against RSV for immunocompromised children younger than 24 months. However, guidance on immunoprophylaxis for this population has not been clear due to the exclusion of immunocompromised children from clinical trials. Therefore, researchers systematically reviewed data from 6 studies published between 2014 and 2022 that supported the use of palivizumab in children with primary or acquired immunodeficiency.

Data on the incidence of RSV-associated hospitalization and mortality was captured from a total of 625 immunocompromised children enrolled in palivizumab programs. Of the 6 reviewed studies, 4 were prospective multicenter observational studies, 2 were retrospective cohort studies, and none included a control group.

Four studies had no recorded RSV-associated hospitalizations among children who received palivizumab. However, data captured from 1 study indicated a statistically insignificant higher risk for hospitalization in children with immunodeficiency when compared with children with complex medical conditions, such as chronic lung disease and congenital heart defects, and when compared with premature infants.

In a study comprising 25,003 pediatric patients, the rate of RSV-associated hospitalizations following palivizumab use was 2.5% for those with immunocompromised conditions and 1.6% for the overall population.

There were no occurrences of RSV-associated mortality recorded in any of the reviewed studies.

Limitations of this analysis include the lack of control groups, highly heterogeneous patient populations, the lack of data on specific immunocompromised conditions, and the evaluation of only RSV-associated hospitalizations and mortality.

“This systematic review highlights the lack of data supporting effective ways to prevent severe RSV outcomes in immunocompromised children,” the researchers concluded.

Disclosure: One study author reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Infectious Disease Advisor