Respiratory Syncytial Virus Immune Globulin Treatment of RSV Lower Respiratory Tract Infection in Previously  Healthy Children

Rodríguez, William J.; Gruber, William C.; Groothuis, Jessie R.; Simões, Eric A F; Rosas, Angela; Lepow, Martha L.; Kramer, Andrew A.; Hemming, Val G.

doi:10.1542/peds.100.6.937

Cited by 130 publications

(81 citation statements)

References 23 publications

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“…We found three RCTs on the use of immune globulin in ICU patients (20)(21)(22). Because the interventions used were so different, we did not combine the data from the studies in a metaanalysis.…”

Section: Immune Globulinmentioning

confidence: 99%

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Davison

Ventre²,

Luchetti³

et al. 2004

Pediatric Critical Care Medicine

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Section: Immune Globulinmentioning

confidence: 99%

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Davison

Ventre²,

Luchetti³

et al. 2004

Pediatric Critical Care Medicine

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“…Moreover, proving a treatment benefit in a complicated condition such as this by comparing one uncontrolled series to another is difficult. Indeed, despite higher RSV loads being linked to disease severity, 24 large well controlled trials studying RSV-IGIV in the treatment of established RSV disease in previously healthy 25 and high risk 26 infants have failed to show a statistically significant treatment effect (a favorable trend was observed in the previously healthy group 25 ). The reason is most likely due to the fact that infection in immuno-competent patients is rapidly cleared, giving little time for the rapid reduction of virus achieved with passive antibody treatment to manifest itself as observable clinical improvement.…”

Section: Tablementioning

confidence: 99%

Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation – a compassionate use experience

DeVincenzo

Hirsch²,

Fuentes³

et al. 2000

Bone Marrow Transplant

112

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Summary:Respiratory syncytial virus (RSV) pneumonia in BMT recipients carries a mortality rate of approximately 50-70% despite ribavirin (Virazole) treatment. In both immunocompetent and immunocompromised animal models, RSV neutralizing antibodies rapidly reduce pulmonary virus load after a single dose. RSV-IGIV (RespiGam) is an IgG immune globulin with high concentrations of RSV neutralizing antibody (Ͼ19 200 MU/ml). From June 1991 to February 1996, a compassionate-use protocol using RSV-IGIV for treatment of RSV infections was conducted. Eleven children at multiple centers, mean age 3.3 years (4 months to 9 years), were undergoing BMT and met the protocol criteria. They received a single 1500 mg/kg dose of RSV-IGIV infused over 12 h at a median of 5 days (1-37 days) after RSV symptom onset. Ten of these patients received prior or concurrent aerosolized ribavirin. Serum RSV neutralizing titers were measured in five patients and showed a 3-to 30-fold increase 24 h after RSV-IGIV infusion. Adverse events were mild. One of 11 (9.1%) patients died from their RSV illness (91% RSV survival). In comparison to previously published reports, RSV-IGIV treatment of RSV pneumonia in BMT patients may increase survival above that in such patients treated with ribavirin alone. Bone Marrow Transplantation (2000) 25, 161-165. Keywords: respiratory syncytial virus; bone marrow transplantation; immune globulin; treatment; ribavirin; palivizumab Respiratory syncytial virus (RSV) is a well recognized and often fatal complication of bone marrow transplantation. Upper or lower respiratory tract infection (URTI/LRTI) with RSV has been reported to occur in 7% to 20% of hospitalized BMT patients, primarily during the 6-month winter season (November to May). 1-3 Many of these RSV infected patients develop pneumonia and face a high risk of mortality. [1][2][3] The reported mortality rate in BMT patients who develop RSV-LRTI approaches 100% for those not treated with antivirals and 50% to 70% for those promptly treated with ribavirin (Virazole). [3][4][5][6][7][8][9][10][11][12][13] From the literature, it appears that there are no survivors among RSV-LRTI transplant patients who progress to mechanical ventilation before antiviral therapy has been initiated. 2,12 Although RSV pneumonia occurring more than 100 days post-BMT has been associated with lower mortality rates, 12,13 the mortality rate of RSV pneumonia does not differ before and after engraftment during the early post-transplant period. 3,14 Aerosolized ribavirin is the only Federal Drug Administration (FDA) approved drug for treatment of established RSV disease, 15 but its efficacy in BMT patients with RSV pneumonia is considered poor. The beneficial effects of immune globulin therapy on established RSV disease have been clearly demonstrated in experimental animals. In both immunocompetent and immunocompromised animal models of RSV infection, IgG immune globulin preparations have been shown to rapidly reduce the pulmonary virus load after a single large parenteral dose. [16][17][1...

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“…24,25,[27][28][29] No statistically significant difference was observed between IL-2 levels in nasopharyngeal secretion and disease severity assessed by hemoglobin oxygen saturation (pulse oximetry), Modified Clinical Scoring System, time on supplemental oxygen, length of hospital stay, and necessity of MV. Necessity of intensive care admission was not considered in the assessment of disease severity, since patients were selected from two hospitals with distinct healthcare characteristics.…”

Section: Discussionmentioning

confidence: 93%

Concentrações de interleucina-2 na secreção nasofaríngea de crianças com bronquiolite viral aguda pelo vírus respiratório sincicial

Giugno¹,

Amantéa²,

Barreto³

2004

J. Pediatr. (Rio J.)

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Objective: To assess interleukin-2 concentrations in nasopharyngeal secretion of children (0-24 months) with acute respiratory syncytial virus bronchiolitis, within the first 12 hours of hospital admission, and compare the levels of IL-2 with the severity of the illness.Methods: Prospective study performed between June and August 1999. The study included 62 patients, previously healthy, hospitalized with acute viral bronchiolitis characterized by recent prodromes of coryza and/or nasal obstruction, which evolved to at least two of the following signs: respiratory dysfunction, tachypnea, wheezing or rales, and detection of respiratory syncytial virus in nasopharyngeal aspirate. The nasopharyngeal specimens were collected within 12 hours of hospital admission. The interleukin-2 levels were obtained by enzyme immunoassay. Severity of illness was assessed through oxygen saturation by pulse oximetry, Modified Clinical Score System, time of supplemental oxygen required, length of hospital stay, and mechanical ventilation. Spearman s correlation and Kruskal-Wallis test were used to compared these variables in relation to the median of interleukin-2. The chi-square test was used for categorical analysis of interleukin-2.Results: The mean age of patients was 2.2 (1.3-4) months. Males comprised 54% of cases. Hemoglobin oxygen saturation by pulse oximetry at hospital admission was below 95% in 66.1% of patients. The mean time of supplemental oxygen use was 4.7 days (±3.54). The mean length of hospital stay was 4.25 days (±1.76). Mechanical ventilation was used in 4.8% of patients. The values of interleukin-2 in nasopharyngeal aspirates varied from 0 to 40,256 ng/ml with median of 86 ng/ml (4.4 457.3). The study showed no statistical difference between levels of IL-2 and severity of illness. Conclusions:The interleukin-2 levels showed a heterogeneous behavior. We found no association between interleukin-2 levels in nasopharyngeal secretion and respiratory syncytial virus bronchiolitis.J Pediatr (Rio J). 2004;80(4):315-20: Interleukin-2, acute viral bronchiolitis, respiratory syncytial virus, nasopharyngeal aspirates.

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Respiratory Syncytial Virus Immune Globulin Treatment of RSV Lower Respiratory Tract Infection in Previously Healthy Children

Cited by 130 publications

References 23 publications

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Respiratory syncytial virus immune globulin treatment of lower respiratory tract infection in pediatric patients undergoing bone marrow transplantation – a compassionate use experience

Concentrações de interleucina-2 na secreção nasofaríngea de crianças com bronquiolite viral aguda pelo vírus respiratório sincicial

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