Lanzhou, China—Pediatric hospitals in the United States were overwhelmed in the fall and earlier this winter with RSV, the leading cause of acute lower respiratory infection in children aged younger than 5 years.

Could greater use of monoclonal antibodies for the prevention of RSV infection in infants and children be the answer?

A recent study from China sought to determine whether that would be the case. The study team compared the efficacy and safety of monoclonal antibodies in a systematic review and network meta-analysis of PubMed, Embase, CENTRAL, and Those databases were searched from inception to March 2022, and results were published in the Journal of the American Medical Association Network Open.

The researchers focused on randomized clinical trials that enrolled infants at high risk of RSV infection to receive a monoclonal antibody or placebo. Teams of two reviewers independently performed literature screening, data extraction, and risk of bias assessment.

The main outcomes were defined as all-cause mortality, RSV-related hospitalization, RSV-related infection, drug-related adverse events, ICU admission, supplemental oxygen use, and mechanical ventilation use.

Ultimately, 15 randomized clinical trials involving 18,395 participants were deemed eligible, and 14—with 18,042 total participants (median age at study entry, 3.99 months interquartile range [IQR], 3.25-6.58 months]; median proportion of males, 52.37% [IQR, 50.49%-53.85%])—were synthesized.

The key findings included that nirsevimab, motavizumab, and palivizumab were associated with significant reductions in RSV-related hospitalization, infection, and supplemental oxygen use, while motavizumab was associated with a significantly larger reduction in RSV infection, ICU admissions, and mechanical ventilation use compared with palivizumab.

“The findings suggest that motavizumab, nirsevimab, and palivizumab are associated with substantial benefits in the prevention of RSV infection in infants and children,” the authors wrote. “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.”

While the monoclonal antibodies were associated with substantial benefits in the prevention of RSV infection, no significant increase in adverse events were detected compared with placebo. The researchers called for more research to confirm their conclusions, especially in terms of safety and cost-effectiveness.

Background information in the article noted that approximately 2.1 million children aged younger than 5 years require inpatient or outpatient treatment for RSV infection each year, with the overall mortality of RSV disease worldwide calculated as one in 28 deaths among infants aged 28 days to 6 months.

While vaccines are being developed to help prevent RSV, the study said that “effective RSV prevention strategies are urgently needed to address this major public health issue and burden.”

Currently, palivizumab is the most widely used prophylaxis for preventing RSV disease in infants. That monoclonal antibody is not available in some countries, and is too costly for many middle- and low-income families, according to the report.

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