title: Palivizumab for prophylaxis against respiratory syncytial virus infection in children with cystic fibrosis.
abstract: BACKGROUND
  Respiratory syncytial virus infection causes acute lung infection in infants and young children worldwide, resulting in considerable morbidity and mortality. Children with cystic fibrosis are prone to recurrent lung inflammation, bacterial colonisation and subsequent chronic airway disease, putting them at risk for severe respiratory syncytial virus infections requiring intensive care and respiratory support. No treatment currently exists, hence prevention is important. Palivizumab is effective in reducing respiratory syncytial virus hospitalisation rates and is recommended for prophylaxis in high-risk children with other conditions. It is unclear if palivizumab can prevent respiratory syncytial virus hospitalisations and intensive care unit admissions in children with cystic fibrosis.
  
  
  OBJECTIVE
  To determine the efficacy and safety of palivizumab (Synagis(®)) compared with placebo, no prophylaxis or other prophylaxis, in preventing hospitalisation and mortality from respiratory syncytial virus infection in children with cystic fibrosis.
  
  
  METHODS
  We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register and scanned references of the eligible study and related reviews.Date of last search: 25 October 2011.
  
  
  METHODS
  Randomised and quasi-randomised studies.
  
  
  METHODS
  The authors independently extracted data and assessed risk of bias.
  
  
  RESULTS
  One study (186 infants up to two years old) comparing five monthly doses of palivizumab (N = 92) to placebo (N = 94) over one respiratory syncytial virus season was identified and met our inclusion criteria. At six months follow-up, one participant in each group was hospitalised due to respiratory syncytial virus; there were no deaths in either group. In the palivizumab and placebo groups, 86 and 90 children experienced any adverse event, while 5 and 4 children had related adverse events respectively. Nineteeen children receiving palivizumab and 16 receiving placebo suffered serious adverse events; one participant receiving palivizumab discontinued due to this. At 12 months follow-up, there were no significant differences between groups in number of Pseudomonas bacterial colonisations or change in weight-to-height ratio.
  
  
  CONCLUSIONS
  We identified one randomised controlled trial comparing five monthly doses of palivizumab to placebo in infants up to two years old with cystic fibrosis. While the overall incidence of adverse events was similar in both groups, it is not possible to draw conclusions on the safety and tolerability of respiratory syncytial virus prophylaxis with palivizumab in infants with cystic fibrosis because the trial did not specify how adverse events were classified. Six months after treatment, the authors reported no clinically meaningful differences in outcomes; however no data were provided. Additional randomised studies are needed to establish the safety and efficacy of palivizumab in children with cystic fibrosis.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. krobin@jhmi.edu.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
authors.forename: Olaide A
authors.initials: OA
authors.lastname: Odelola
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Saldanha
authors.forename: Naomi A
authors.initials: NA
authors.lastname: McKoy
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans; D007223:Infant; D000069455:Palivizumab; D011552:Pseudomonas Infections / Q000453:epidemiology; D011550:Pseudomonas aeruginosa; D016032:Randomized Controlled Trials as Topic; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab