Respiratory Syncytial Virus Immunoprophylaxis in High-Risk Infants and Development of Childhood Asthma

Publication date: Available online 21 April 2016
Source:Journal of Allergy and Clinical Immunology
Author(s): Kecia N. Carroll, Tebeb Gebretsadik, Gabriel J. Escobar, Pingsheng Wu, Sherian Xu Li, Eileen M. Walsh, Ed Mitchel, Chantel D. Sloan, William D. Dupont, Tina V. Hartert
BackgroundRespiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV immunoprophylaxis during infancy is efficacious in preventing RSV hospitalizations and has been associated with decreased wheezing in the first years of life.ObjectiveWe investigated whether greater adherence to immunoprophylaxis in infants at high-risk for severe RSV would be associated with decreased childhood asthma.MethodsWe conducted a retrospective cohort investigation including children born 1996-2003, enrolled in Kaiser Permanente Northern California or Tennessee Medicaid, and eligible to receive RSV immunoprophylaxis. Asthma was defined at 4.5-6 years using asthma-specific healthcare visits and medication fills. We classified children into immunoprophylaxis eligibility groups and calculated adherence (% receipt of recommended doses). We employed a set of statistical strategies (multivariable logistic regression, propensity score (PS)-adjusted and-matched analyses) to overcome confounding by medical complexity, as infants with higher adherence (>70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays.ResultsUsing multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV immunoprophylaxis was not associated with decreased asthma. However in PS-matched analysis, treated children with >70% adherence had decreased odds of asthma compared to those with <20% adherence (odds ratio 0.62: 95% CI 0.50, 0.78).ConclusionsThis investigation of RSV immunoprophylaxis in high-risk children primarily found non-significant associations on prevention of asthma in specific preterm groups. Findings highlight need for larger studies, prospective cohorts, and provide estimates of potential preventive effect sizes in high-risk children.

Teaser

Odds of childhood asthma among high-risk infants receiving RSV immunoprophylaxis varied by eligibility group and statistical method applied. Prospective studies are needed, but these findings provide estimates of effect sizes in specific sub-groups.


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