Palivizumab administration in preterm infants in France: EPIPAGE-2 cohort study

Several countries, including France, have restricted the indications for monoclonal antibodies directed against respiratory syncytial virus (RSV) compared to the marketing authorization (MA). No new data concerning use of palivizumab on a national scale have been published since the 2007 update of the national guidelines. To describe palivizumab administration for RSV prophylaxis during the first RSV season in infants born prematurely in France in 2011. Infants from the national population-based cohort EPIPAGE-2 born at≤34 weeks’ gestation, discharged home before 31 March 2012 and followed-up at 1year were included. The RSV season ran from 1 October 2011 to 31 March 2012. Prophylaxis was deemed “initiated” if the infant had received at least one dose of palivizumab during this period and “complete” if it had received at least five doses or as many doses as the number of exposed months. The reference documents were the MA and French Transparency Committee guidelines (TC). Prophylaxis was indicated in 3586 of 3608 infants (99.7%) according to the MA and 1315 of 3608 (16.7%) according to the TC. A total of 1906 infants (26.6%) received at least one dose of palivizumab. The overall rate of conformity with TC indications was 85%, but was lower for infants born at 27–32 weeks’ gestation. The rate of complete prophylaxis was 77.2%. The factors associated with prophylaxis initiation were low gestational age, low birthweight, high maternal educational level, type of neonatal unit, and date at discharge. Factors associated with complete prophylaxis were respiratory impairment, high educational level, and characteristics related to living conditions (absence of siblings at home, type of childcare). Palivizumab administration in France generally conformed with TC guidelines, but could be further improved for infants born at 27–32 weeks’ gestation without bronchopulmonary dysplasia.