Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing.
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.


METHODS
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.
Simoes
Eric A F
EA
Department of Pediatric Infectious Diseases, University of Colorado School of Medicine and The Children's Hospital, Denver, CO 80218, USA. eric.simoes@uchsc.edu
Groothuis
Jessie R
JR
Carbonell-Estrany
Xavier
X
Rieger
Christian H L
CH
Mitchell
Ian
I
Fredrick
Linda M
LM
Kimpen
Jan L L
JL
D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D000069455:Palivizumab; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012135:Respiratory Sounds / Q000175:diagnosis / Q000187:drug effects*; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses / Q000187:drug effects; D018570:Risk Assessment; D055502:Secondary Prevention; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab