This study presents a review of the treatment and prevention strategies for respiratory syncytial virus.
Respiratory syncytial virus (RSV) is a common cause of severe lower respiratory tract disease globally, especially in young children. Despite its high prevalence and morbidity, the available therapy is mostly supportive. Recent developments in novel therapies offer hope for reducing the disease impact. A study in the journal Pathogens reviewed the available options and investigational agents for the treatment and prophylaxis of RSV.
Specific Therapies
Ribavirin, a nucleoside analog that inhibits viral replication, has shown significant benefits in immunocompromised patients; however, it is not recommended for previously healthy children due to its high cost and adverse effects. Other promising investigational antiviral agents are RV521 and AK0529.
Palivizumab and motavizumab, anti-RSV monoclonal antibodies, have not demonstrated statistically significant results for infection treatment. There is insufficient evidence for RSV-immune globulin (RSV-IVIG), a polyclonal neutralizing antibody that was discontinued after the approval of palivizumab.
Non-Specific Therapies
Therapies for airway obstruction can be utilized; however, they are not recommended as standard treatment due to a lack of supporting evidence and require further research. These include mucolytic agents like deoxyribonuclease, N-acetylcysteine, and nebulized hypertonic saline.
Deoxyribonuclease may be considered in severe cases with atelectasis after conventional therapy failure.
Salbutamol and albuterol can be trialed in infants with wheeze to assess response. Epinephrine may be used for acute management.
Glucocorticoids can be considered where reactive airway disease is strongly suspected.
Chest physiotherapy can be considered with relevant comorbidities, notably underlying neuromuscular diagnoses that would impair the ability to cough. High-dose inhaled nitric oxide has been suggested for RSV bronchiolitis and showed promising results in a small trial.
Prophylactic Agents
No vaccine has yet been approved for RSV prevention. The last decade has shown an increase in vaccine trials, with 34 vaccines currently in development. Three recombinant-vector-based vaccine candidates are in phase 2–3 trials for pediatric and elderly populations. A phase-1 trial of a nucleic-acid-based mRNA vaccine in adults met the safety and immunogenicity outcomes. Many protein-based vaccines are in different trial stages for older adults or mothers (for passive infant immunity).
Live-attenuated vaccines have shown a good safety profile in infants and an 88% efficacy rate against medically attended acute lower respiratory disease for the five most promising vaccine candidates. Monoclonal antibodies provide passive immunization. Palivizumab is an approved drug for RSV prophylaxis with good efficacy but a high cost, and it requires repeated monthly administrations.
Motavizumab has demonstrated a lack of superiority over palivizumab in trials and a higher incidence of adverse effects. In clinical trials, Nirsevimab, an anti-F-RSV IgG antibody, showed a 70–75% reduction in RSV-associated, medically-attended lower respiratory tract infections. The European Union recently approved it for RSV prevention. Many other monoclonal antibodies are also under investigation.
Source
Gatt, D., Martin, I., AlFouzan, R., & Moraes, T. J. (2023). Prevention and Treatment Strategies for Respiratory Syncytial Virus (RSV). Pathogens, 12(2), 154. https://doi.org/10.3390/pathogens12020154