High Titer Respiratory Syncytial Virus Immune Globulin (RSVIG) Is Effective for Prevention of RSV Hospitalization. A Meta-Analysis:

Abstract 622 Poster Session I, Saturday, 5/1 (poster 178) Objectives: To determine the efficacy of passive prophylaxis in preventing RSV hospitalization in high-risk populations. Methods: A search of the bibliographic database MEDLINE was performed July, 1997 and updated July, 1998 using medical subject headings, "respiratory syncytial virus," respiratory syncytial virus infection," "immune globulin," and "respiratory syncytial virus immune globulin." All randomized controlled trials of IVIG or RSVIG for prevention of RSV were identified and reviewed by 2 authors. Two trials which were 'in press' at the time and subsequently published were also included. Data were independently abstracted for 4 outcomes. The primary outcome was incidence of hospitalization. Secondary outcomes were rates of ICU admission, mechanical ventilation, and mortality. Results: Three trials were randomized but not blinded and two were randomized and blinded. One trial examined IVIG, three trials examined polyclonal RSVIG and one trial examined monoclonal RSVIG. We are aware of a negative trial of another monoclonal RSVIG that has not been published and could not be included. The Peto odds ratios were 0.48 (0.37, 0.64), 0.47 (0.29, 0.77), and 0.99 (0.48, 2.07) for incidence of hospitalization, ICU admission and mechanical ventilation with RSVIG prophylaxis, respectively. This was essentially the same as the rates for prophylaxis with either RSVIG or IVIG. Odds Ratios for hospitalization was 0.27 (0.15, 0.49) for premature infants without BPD and 0.59 (0.37, 0.8) for the BPD sub-group. OR for Mortality was 1.15 (0.63, 2.11) overall and 1.26 (0.59, 2.70) in the cardiac subgroup. (Figure) Conclusions: RSVIG is effective in preventing RSV hospitalizations in premature infants with or without BPD. However, the cost of the product and its administration outweigh the cost of hospitalization. This does not take into consideration the advantages to the family of avoiding hospitalization or unknown potential long term advantages. Intramuscular administration of the monoclonal product may confer a greater cost advantage of prophylaxis.