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- Title
Monoclonal Antibody for the Prevention of Respiratory Syncytial Virus in Infants and Children: A Systematic Review and Network Meta-analysis.
- Authors
Sun, Mingyao; Lai, Honghao; Na, Feiyang; Li, Sheng; Qiu, Xia; Tian, Jinhui; Zhang, Zhigang; Ge, Long
- Abstract
This systematic review and network meta-analysis compares the efficacy and safety of 4 monoclonal antibodies for preventing respiratory syncytial virus among infants and children. Key Points: Question: What is the most appropriate monoclonal antibody (mAb) for the prevention of respiratory syncytial virus (RSV) in infants and children? Findings: In this systematic review and network meta-analysis of 14 randomized clinical trials assessing efficacy and safety of 4 mAbs, nirsevimab, motavizumab, and palivizumab were associated with significant reductions in RSV-related hospitalization, infection, and supplemental oxygen use. Motavizumab was associated with a significantly larger reduction in RSV infection, intensive care unit admissions, and mechanical ventilation use than palivizumab. Meaning: The findings suggest that motavizumab, nirsevimab, and palivizumab are associated with substantial benefits in the prevention of RSV infection in infants and children. Importance: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection in children younger than 5 years; effective prevention strategies are urgently needed. Objective: To compare the efficacy and safety of monoclonal antibodies for the prevention of RSV infection in infants and children. Data Sources: In this systematic review and network meta-analysis, PubMed, Embase, CENTRAL, and ClinicalTrials.gov were searched from database inception to March 2022. Study Selection: Randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo were included. Keywords and extensive vocabulary related to monoclonal antibodies, RSV, and randomized clinical trials were searched. Data Extraction and Synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was used. Teams of 2 reviewers independently performed literature screening, data extraction, and risk of bias assessment. The Grading of Recommendations, Assessments, Developments, and Evaluation approach was used to rate the certainty of evidence. A random-effects model network meta-analysis was conducted using a consistency model under the frequentist framework. Main Outcomes and Measures: The main outcomes were all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, intensive care unit admission, supplemental oxygen use, and mechanical ventilation use. Results: Fifteen randomized clinical trials involving 18 395 participants were eligible; 14 were synthesized, with 18 042 total participants (median age at study entry, 3.99 months [IQR, 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%]). Compared with placebo, with moderate- to high-certainty evidence, nirsevimab, palivizumab, and motavizumab were associated with significantly reduced RSV-related infections per 1000 participants (nirsevimab: −123 [95% CI, −138 to −100]; palivizumab: −108 [95% CI, −127 to −82]; motavizumab: −136 [95% CI, −146 to −125]) and RSV-related hospitalizations per 1000 participants (nirsevimab: −54 [95% CI, −64 to −38; palivizumab: −39 [95% CI, −48 to −28]; motavizumab: −48 [95% CI, −58 to −33]). With moderate-certainty evidence, both motavizumab and palivizumab were associated with significant reductions in intensive care unit admissions per 1000 participants (−8 [95% CI, −9 to −4] and −5 [95% CI, −7 to 0], respectively) and supplemental oxygen use per 1000 participants (−59 [95% CI, −63 to −54] and −55 [95% CI, −61 to −41], respectively), and nirsevimab was associated with significantly reduced supplemental oxygen use per 1000 participants (−59 [95% CI, −65 to −40]). No significant differences were found in all-cause mortality and drug-related adverse events. Suptavumab did not show any significant benefits for the outcomes of interest. Conclusions and Relevance: In this study, motavizumab, nirsevimab, and palivizumab were associated with substantial benefits in the prevention of RSV infection, without a significant increase in adverse events compared with placebo. However, more research is needed to confirm the present conclusions, especially for safety and cost-effectiveness.
- Subjects
THERAPEUTIC use of monoclonal antibodies; DRUG efficacy; INTENSIVE care units; ONLINE information services; LENGTH of stay in hospitals; MEDICAL databases; META-analysis; CONFIDENCE intervals; MEDICAL information storage &; retrieval systems; IMMUNIZATION; SYSTEMATIC reviews; MONOCLONAL antibodies; RACE; REGRESSION analysis; CONGENITAL heart disease; ARTIFICIAL respiration; MEDICAL protocols; PALIVIZUMAB; DESCRIPTIVE statistics; RESPIRATORY syncytial virus infections; POLYMERASE chain reaction; ODDS ratio; INFANT mortality; MEDLINE; BRONCHOPULMONARY dysplasia; DATA analysis software; CHILDREN
- Publication
JAMA Network Open, 2023, Vol 6, Issue 2, pe230023
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.0023