Palivizumab Prophylaxis, Respiratory Syncytial Virus, and Subsequent Recurrent Wheezing

Received 14 April 2006; received in revised form 28 December 2006; accepted 8 February 2007.

Refers to article:

Respiratory Syncytial Virus Infection and Recurrent Wheezing: A Complex Relationship
H. Cody Meissner, Sarah S. Long
The Journal of Pediatrics
July 2007 (Vol. 151, Issue 1, Pages 6-7)
Full Text | Full-Text PDF (58 KB)

Objective

Children who experience respiratory syncytial virus (RSV) lower respiratory tract infections (LRTIs) early in life have high rates of subsequent recurrent wheezing. Palivizumab, an anti-RSV monoclonal antibody, has 78% to 80% efficacy in preventing RSV hospitalization in premature infants without chronic lung disease. We hypothesized that palivizumab, by ameliorating or preventing early RSV LRTI in preterm infants, might decrease later recurrent wheezing.

Study design

A cohort of preterm infants who had received palivizumab and were not hospitalized for RSV (n = 191) or who never received palivizumab (n = 230; 76 who were hospitalized for RSV and 154 who were not), were prospectively followed for 24 months beginning at a mean age of 19 months. The subjects were assessed for recurrent wheezing by caretaker or physician report.

Results

The incidences of recurrent wheezing and physician-diagnosed recurrent wheezing were significantly lower in the 191 palivizumab-treated subjects (13% and 8%, respectively) compared with all 230 untreated subjects (26%, P = .001 and 16%, P = .011, respectively) and with the 154 patients in the subgroup not hospitalized for RSV LRTI (23%, P = .022 and 16%, P = .027, respectively). The effect of palivizumab treatment remained significant after adjustment for potential confounding variables.

Conclusions

Our study suggests that preventing RSV LRTI with palivizumab may reduce subsequent recurrent wheezing in premature infants.

Abbreviations: CI, Confidence interval, CLD, Chronic lung disease, HR, Hazard ratio, LRTI, Lower respiratory tract infection, RR, Relative risk, RSV, Respiratory syncytial virus

⁎ Department of Pediatric Infectious Diseases, University Of Colorado School Of Medicine and The Children’s Hospital, Denver, CO

† Abbott Laboratories, Inc, Chicago, IL

‡ Neonatology Service, Hospital Clinic, Institute and Clinic of Gynecology, Obstetrics and Neonatology, Barcelona, Spain

§ Department of Pediatrics, St Josef Hospital, Ruhr University, Bochum, Germany

∥ Institute of Maternal and Child Health, University of Calgary, Calgary, Alberta, Canada

¶ Abbott Laboratories, Abbott Park, IL

⁎⁎ Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands.

Reprint requests: Eric A. F. Simoes, MD, DCH, The Children’s Hospital, 1056 E 19th Ave, B070, Denver, CO 80218.

This study was funded by grants from Abbott Laboratories to the individual investigators. The study sponsors collaborated on study design, managed data collection, and performed data analysis.

⁎ The members of the Palivizumab Long-Term Respiratory Outcomes Study Group are listed in an appendix, available at www.jpeds.com.

a Drs Simoes, Groothuis, Carbonell-Estrany, Rieger, Mitchell and Kimpen are members of the Steering Committee of the Palivizumab Long-Term Respiratory Outcomes Study and are consultants for Abbott Laboratories.

b Dr Groothuis currently is Vice President, Medical and Scientific Affairs and Head, Infectious Diseases and Vaccines, MedImmune, Inc.

c Linda Fredrick currently is an employee of Abbott Laboratories.

PII: S0022-3476(07)00161-8

doi:10.1016/j.jpeds.2007.02.032

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