Palivizumab and long-term outcomes in cystic fibrosis

Aliza K. Fink, Gavin Graff, Carrie L. Byington, Deena R. Loeffler, Margaret Rosenfeld, Lisa Saiman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain. METHODS: We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive Pseudomonas respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores. RESULTS: The sample included 4267 infants; 1588 (37%) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95% confidence interval: 96.9-99.5) and did not (97.3; 95% confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive Pseudomonas aeruginosa culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab. CONCLUSIONS: At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.

Original languageEnglish (US)
Article numbere20183495
JournalPediatrics
Volume144
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cystic Fibrosis
Propensity Score
Hospitalization
Confidence Intervals
Palivizumab
Lung
Forced Expiratory Volume
Pseudomonas
Pseudomonas aeruginosa
Lung Diseases
Registries
Chronic Disease
Regression Analysis
Demography
Pediatrics
Population

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Fink, A. K., Graff, G., Byington, C. L., Loeffler, D. R., Rosenfeld, M., & Saiman, L. (2019). Palivizumab and long-term outcomes in cystic fibrosis. Pediatrics, 144(1), [e20183495]. https://doi.org/10.1542/peds.2018-3495
Fink, Aliza K. ; Graff, Gavin ; Byington, Carrie L. ; Loeffler, Deena R. ; Rosenfeld, Margaret ; Saiman, Lisa. / Palivizumab and long-term outcomes in cystic fibrosis. In: Pediatrics. 2019 ; Vol. 144, No. 1.
@article{76a37fad85024f62acd4edabece34024,
title = "Palivizumab and long-term outcomes in cystic fibrosis",
abstract = "BACKGROUND: The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain. METHODS: We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive Pseudomonas respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores. RESULTS: The sample included 4267 infants; 1588 (37{\%}) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95{\%} confidence interval: 96.9-99.5) and did not (97.3; 95{\%} confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive Pseudomonas aeruginosa culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab. CONCLUSIONS: At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.",
author = "Fink, {Aliza K.} and Gavin Graff and Byington, {Carrie L.} and Loeffler, {Deena R.} and Margaret Rosenfeld and Lisa Saiman",
year = "2019",
month = "1",
day = "1",
doi = "10.1542/peds.2018-3495",
language = "English (US)",
volume = "144",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "1",

}

Fink, AK, Graff, G, Byington, CL, Loeffler, DR, Rosenfeld, M & Saiman, L 2019, 'Palivizumab and long-term outcomes in cystic fibrosis', Pediatrics, vol. 144, no. 1, e20183495. https://doi.org/10.1542/peds.2018-3495

Palivizumab and long-term outcomes in cystic fibrosis. / Fink, Aliza K.; Graff, Gavin; Byington, Carrie L.; Loeffler, Deena R.; Rosenfeld, Margaret; Saiman, Lisa.

In: Pediatrics, Vol. 144, No. 1, e20183495, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Palivizumab and long-term outcomes in cystic fibrosis

AU - Fink, Aliza K.

AU - Graff, Gavin

AU - Byington, Carrie L.

AU - Loeffler, Deena R.

AU - Rosenfeld, Margaret

AU - Saiman, Lisa

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain. METHODS: We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive Pseudomonas respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores. RESULTS: The sample included 4267 infants; 1588 (37%) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95% confidence interval: 96.9-99.5) and did not (97.3; 95% confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive Pseudomonas aeruginosa culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab. CONCLUSIONS: At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.

AB - BACKGROUND: The American Academy of Pediatrics does not recommend routine use of palivizumab prophylaxis for infants with cystic fibrosis (CF) but recommends consideration in infants with clinical evidence of chronic lung disease or nutritional compromise. However, the beneficial impact of palivizumab on longer-term outcomes is uncertain. METHODS: We used Cystic Fibrosis Foundation Patient Registry data to assess the association of receiving palivizumab during the first 2 years of life with longer-term outcomes, including lung function at 7 years old, time to first positive Pseudomonas respiratory culture, and pulmonary-related hospitalizations during the first 7 years of life. Eligible infants were born from 2008 to 2015 and diagnosed with CF during the first 6 months of life. Demographic and clinical confounders of association between palivizumab receipt and outcomes were explored. We created propensity scores to adjust for potential confounding by indication (ie, sicker infants were more likely to receive palivizumab). For each outcome, we performed regression analyses adjusted by propensity scores. RESULTS: The sample included 4267 infants; 1588 (37%) received palivizumab. Mean percent forced expiratory volume in 1 second predicted at 7 years old was similar among those who did (98.2; 95% confidence interval: 96.9-99.5) and did not (97.3; 95% confidence interval: 96.1-98.5) received palivizumab, adjusting for propensity scores. Time to first positive Pseudomonas aeruginosa culture and annual risk of hospitalization were similar among those who did and did not receive palivizumab. CONCLUSIONS: At the population level, palivizumab receipt was not associated with improved longer-term outcomes in children with CF.

UR - http://www.scopus.com/inward/record.url?scp=85068888292&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068888292&partnerID=8YFLogxK

U2 - 10.1542/peds.2018-3495

DO - 10.1542/peds.2018-3495

M3 - Article

C2 - 31239289

AN - SCOPUS:85068888292

VL - 144

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 1

M1 - e20183495

ER -

Fink AK, Graff G, Byington CL, Loeffler DR, Rosenfeld M, Saiman L. Palivizumab and long-term outcomes in cystic fibrosis. Pediatrics. 2019 Jan 1;144(1). e20183495. https://doi.org/10.1542/peds.2018-3495