Monoclonal Antibodies for the Prevention of Respiratory Syncytial Virus in Infants and Children: An Updated Systematic Review and Network Meta-analysis

Background and objective: Motivated by the emergence of a long-acting monoclonal antibody (clesrovimab), the availability of data from the complete MELODY trial cohort, and results from a large randomized trial (HARMONIE), we updated our prior network meta-analysis to evaluate the efficacy and safety of monoclonal antibodies for preventing severe respiratory syncytial virus (RSV) infection in infants.

Methods

We searched for randomized controlled trials that examined the efficacy and safety of RSV infection prophylaxis with clesrovimab, motavizumab, nirsevimab, palivizumab, and suptavumab versus one another or placebo or no prophylaxis in infants. We performed a frequentist framework random-effects network meta-analysis and used the Grading of Recommendations, Assessments, Developments and Evaluation (GRADE) approach to assess the certainty of evidence.