Current and emerging pharmacotherapy for respiratory syncytial virus (RSV) infection in infants

ABSTRACT

Introduction

Respiratory syncytial virus (RSV) is a common respiratory virus with a huge impact on patients, the healthcare system, and society worldwide. Very few effective chances of prevention and treatment of RSV infection are available.

Areas covered

In this paper, knowledge on RSV characteristics and current stage of development of new pharmacological measures against this virus are discussed.

Expert opinion

In recent years, the structure of RSV was explored in depth and several pharmacologic measures potentially effective for prevention and treatment of RSV infection and disease were identified. These new measures have the aim to overcome the limitations of palivizumab and ribavirin. Strategies to protect infants through immunization of pregnant women and/or the use of more effective monoclonal antibodies were developed. At the same time, it was defined which vaccines could be administered to unprimed infants to avoid the risk of enhanced respiratory disease and which vaccines could be effective in older patients and in subjects with reduced immune system efficiency. Finally, a great number of new antiviral drugs targeting the RSV proteins that allow RSV entering host cells or regulate virus replication were produced. Although further studies are needed, some preparations seem effective and safe, making the future of RSV infection prevention and treatment less gloomy.

KEYWORDS:

• RSV
• antiviral
• monoclonal antibodies
• nirsevimab
• respiratory tract infection
• vaccines

Article highlights

• RSV is a common respiratory virus that in otherwise healthy older children, adolescents, and adults generally causes mild to moderate cold-like symptoms, whereas it can be very dangerous in infants, immunocompromised patients and old people in whom it can cause very severe bronchiolitis and pneumonia.

• The evidence that RSV infection will continue to have a huge impact on patients, the healthcare system and society worldwide indicates that effective preventive and therapeutic pharmacological measures against RSV infection would be extremely needed.

• In recent years the structure of RSV was explored in depth and several conserved, highly immunogenic epitopes capable of inducing a protective immune response and proteins whose inhibition could significantly impair virus life cycle were detected.

• A monoclonal antibody, nirsevimab, was found safe, effective, and easy to administer in neonates and younger infants and has been recently authorized for prevention of RSV infection in all the children, largely overcoming the limitation of palivizumab.

• Among RSV vaccines, two subunit vaccines, GSK3844766A and PF-06928316, were found to show sufficient performances of safety and efficacy in phase 3 studies carried out in pregnant women and the elderly.

• Less optimistic is the situation regarding antivirals, among which only ziretovir was found to have a satisfactory antiviral effect when administered to children.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

N Principi wrote the first draft of the manuscript; G Autore, analyzed the literature; S Perrone gave a substantial scientific contribution; S Esposito revised the manuscript and gave a substantial scientific contribution. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.