An assessment of the use of palivizumab over 12 years from a Canadian Registry (CARESS)

Abstract

Background: CARESS, Canadian palivizumab usage registry, tracks utilization & respiratory illnesses. Individual clinicians decide on palivizumab use.

Aims: To provide information on management and outcome of children given palivizumab, whatever the indications; to inform on real life use; to track changes in practice over time.

Design: The registry enrols children from 37 sites in Canada who receive >1 dose of palivizamab. Data collected monthly.

Results: 25,003 children were enrolled from 2005 to 2017. Average age at enrolment was 5.7 ± 6.4 months old; mean gestational age of 32.6 ± 5.0 weeks.1724 children were hospitalized 2054 times, overall respiratory illness-related hospitalization (RIH) rate was 6.9%. The lowest rate of hospitalization was in preterm infants (4.3%) .1474 of 1724 were tested for RSV, and 334 children were RSV-positive, a cumulative RSV-positive hospitalization rate (RSVH) of 1.6%. Indications for palivizumab changed over time. Percentage of those with Bronchopulmonary dysplasia/Chronic Lung Disease remained in the range 10.6-8.8% while premature fell from 74.4% to 66/1%, congenital heart disease peaked at 12.5% 2013-15. Usage in the “other” group (medical complexity) rose from 5.6% to 22.6% (2013-15). The numbers (&%) with specific diagnoses were: Trisomy 21 942 (21.2), Congenital airway anomaly 855 (19.2), Neurological disorders 471 (10.6), Cystic fibrosis 442 (9.9) other pulmonary 438 (9.8). The remainder were children with multiple indications, or individually less common diseases.

Conclusions: Palivizamab is effective in many groups of infants as shown by the comparison of RSVH versus RIH. Palivizumab use increased over time in children with medical complexity.