Results of a systematic review and network meta-analysis published in JAMA Network Open suggest that treatment with motavizumab, nirsevimab, or palivizumab is significantly protective against respiratory syncytial virus (RSV) infection among vulnerable infants.
Researchers at Lanzhou University in China searched publication databases through March 2022 for randomized controlled trials (RCTs) conducted among patients with an increased risk for RSV infection. The researchers specifically searched for studies comprising infants younger than 6 months with chronic lung disease of prematurity or congenital heart disease. Outcomes were compared between patients who received monoclonal antibody (mAbs) and those who received placebo. Metaregression analyses were performed to control for gestational age and the number of male patients.
The final analysis included a total of 15 RCTs, representing 18,395 patients. The median patient age was 3.99 (IQR, 3.25-6.58) months, the median gestational age was 33.1 (IQR, 31.1-35) weeks, and 52.37% were boys.
The active interventions included palivizumab (n=6053), motavizumab (n=5457), nirsevimab (n=2034), suptavumab (n=766), and motavizumab plus palivizumab (n=166); the remaining 3711 patients received placebo.
The researchers found that the risk for hospitalization due to RSV infection was decreased among patients who received either nirsevimab (odds ratio [OR], 0.25; 95% CI, 0.13-0.47) or palivizumab (OR, 0.45; 95% CI, 0.34-0.60) compared with those who received placebo.
There also was a decreased risk for RSV infection observed among patients who received motavizumab (OR, 0.17; 95% CI, 0.12-0.23), nirsevimab (OR, 0.24; 95% CI, 0.16-0.37), or palivizumab (OR, 0.32; 95% CI, 0.22-0.47) compared with those who received placebo. Of the mAb treatments evaluated for RSV prevention, motavizumab was favored over palivizumab (OR, 0.52; 95% CI, 0.32-0.86).
Patients who received motavizumab (OR, 0.12; 95% CI, 0.07-0.19), nirsevimab (OR, 0.13; 95% CI, 0.04-0.39), or palivizumab (OR, 0.18; 95% CI, 0.09-0.37) were less likely to require supplemental oxygen compared with placebo recipients. In addition, fewer motavizumab recipients required mechanical ventilation compared with placebo (OR, 0.14; 95% CI, 0.03-0.57) or palivizumab (OR, 0.23; 95% CI, 0.06-0.83) recipients.
Further analysis showed a decreased risk for intensive care unit (ICU) admission among patients who received either nirsevimab (OR, 0.04; 95% CI, 0.00-0.81), motavizumab (OR, 0.23; 95% CI, 0.09-0.59), or palivizumab (OR, 0.50; 95% CI, 0.26-0.95) compared with those who received placebo. Of the active interventions, motavizumab was associated with lower risk for ICU transfer compared with palivizumab (OR, 0.47; 95% CI, 0.23-0.97).
There were no significant differences between mAb treatments and placebo in regard to adverse events and all-cause mortality outcomes.
Study limitations include a lack of direct evidence as outcomes were ascertained through indirect comparisons.
According to the researchers, “These findings suggest that motavizumab, nirsevimab, and palivizumab are associated with substantial benefits in the prevention of RSV infection in infants and children.”
Sun M, Lai H, Na F, et al. Monoclonal antibody for the prevention of respiratory syncytial virus in infants and children: a systematic review and network meta-analysis. JAMA Netw Open. 2023;6(2):e230023. doi:10.1001/jamanetworkopen.2023.0023