Immunoglobulin treatment for respiratory syncytial virus infection
Abstract
Background
Respiratory syncytial virus (RSV) bronchiolitis and pneumonia hospitalise 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 injections of the humanised 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 humanised immunoglobulin therapy to supportive therapy in infants hospitalised with laboratory‐determined RSV infection.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 1) which contains the Acute Respiratory Infections Group's specialized regsiter, 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 hospitalised 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 of 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).
PICOs
Plain language summary
Many infants are hospitalised each year for lower respiratory tract infections, the majority of which are caused by the respiratory syncytial virus (RSV)
Currently the mainstay of treatment is to support the infants with oxygen and fluids and assist their breathing if necessary. One antiviral therapy (ribavirin) has been approved for use in severe infections but systematic reviews have shown that it is unlikely to give any benefit. Another type of therapy is to give antibodies (immunoglobulins) which target the virus as a preventative measure; this has been shown to be effective. This review assesses whether giving antibody ('immunoglobulins') as treatment is more effective than supportive therapies alone. Only four papers fitted the inclusion criteria. Their results suggest no added benefit.
