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At-Home RSV Prophylaxis Aids Compliance


 

PHILADELPHIA — Infants who receive prophylactic palivizumab at home are more likely to get all their doses on time than are those who receive the injections at their pediatrician's office, Dr. Caroline O. Chua reported at the annual meeting of the Eastern Society for Pediatric Research.

Children getting the injections at home also had fewer hospitalizations for respiratory syncytial virus (RSV) infections, although the difference was not statistically significant, said Dr. Chua of the Maria Fareri Children's Hospital, Valhalla, N.Y.

Her prospective review included 1,362 infants eligible for RSV prophylaxis during the 2005–2006 RSV season. After discharge from the neonatal intensive care unit, 744 of the infants were scheduled to receive monthly injections in their pediatricians' offices. The remaining 618 were scheduled to receive the injections at home through the services of a home health care agency.

All of the infants received their first dose of the drug within 24–48 hours of discharge. But infants scheduled for at-home therapy received significantly more of their scheduled doses on time (95% compliance rate) than did the in-office group (91% compliance rate). Total hospitalizations, including those secondary to RSV infection, were significantly higher in the in-office group than in the in-home group (16 vs. 2).

Hospitalizations from RSV infections only also were higher in the in-office group, but the difference wasn't statistically significant (5 vs. 1).

Although the in-office compliance rate leaves something to be desired, it shows a significant improvement from the rate observed in a similar study in the same community during the 2001–2002 RSV season, Dr. Chua said. That study followed 1,446 infants, 969 of whom received their monthly injections at home. The compliance rate was significantly higher than that observed among the 477 who received their injections in the office setting (98% vs. 89%) (Ped. Infect. Dis. 2004;23:318–22).

“We speculate that the increased compliance in offices could be a reflection of better education on the part of pediatricians or media exposure that reached parents,” she said.

The half-life of palivizumab is only 20 days, Dr. Chua noted. Compliance with the monthly dosing schedule is important to maintain a constantly active trough serum level of the drug (more than 40 mcg/mL).

Increased compliance in offices could mean better education. DR. CHUA

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