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Treatments for RESPIRATORY SYNCYTIAL VIRUS (RSV)
-Understanding Your Options

Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory infection in children and increasingly recognized as an important pathogen in elderly and immune compromised patients. RSV is one of the chief causes of hospitalization for respiratory illness in children. The risk of serious RSV illness in children is highest among infants of prematurity, chronic lung disease, congenital heart disease, multiple congenital anomalies, and certain immunodeficiencies. continued...

Treatment of upper respiratory RSV infection is primarily aimed at symptom alleviation similar to other viral infection that causes upper respiratory infections. No antibiotic therapy is offered without co-bacterial infection because antibiotics do not work in viral infections.

If an infection becomes severe and affects the lower respiratory, then this usually requires hospitalization. Patient may need, as required, respiratory therapy, hydration, administration of humidified oxygen and medications to help open the airways. In severe cases of hypoxia (low oxygen levels), intubation and ventilatory assistance will be required. In such cases, aerosolized ribavirin (Virazole^®), an antiviral agent used for treatment of severe RSV infection, has demonstrated beneficial effect.

Are there medications that prevent RSV infection?
Yes, currently there are two preventative medications on the market called RespiGamâ and Synagis, both manufactured by MedImmune, Inc.

RespiGam^®
RespiGam (Respiratory Syncytial Virus Immune Globulin Intravenous) is a polyclonal antibody approved by the FDA in 1996 for prevention of serious lower respiratory tract infection caused by RSV in children less than 2 years old with bronchopulmonary dysplasia (a form of chronic lung disease causing persistent difficulty breathing) or a history of premature birth. It was one of the first product that demonstrated effectiveness in reducing RSV hospitalization rate by 41% to 65% in high-risk infants.

RespiGam needs to be administered intravenously every month during the RSV season. Because of the very high cost of the medication and the demand of an monthly intravenous administration, RespiGamâ has been largely replaced by Synagis, a next generation in anti-RSV preventative medication.

Synagis^®
Synagis (palivizumab) is a monoclonal antibody directed specifically against a specific protein of the RSV.

1. Treatment Efficacy: In a very important large clinical trial, Synagis prophylaxis during the RSV season resulted in a 55% reduction in RSV hospitalization rate in high-risk infants. Furthermore, since Synagis does not interfere with your child's vaccine shots, your child can receive all of his or her immunization shots as scheduled.

2. High-Risk Infants: According to the American Academy of Pediatrics, infants and children that will benefit from Synagis prophylaxis are:

   a) Infants and children younger than 2 years of age who currently require or have required medical treatment for chronic lung disease within 6 months before the anticipated RSV season.
   b) Infants 12 months of age and younger, at start of the RSV season, born at 28 weeks of gestation or earlier
   c) Infants 6 months of age and younger, at start of the RSV season, born at 29 weeks to 32 weeks of gestation
   d) Infants 6 months of age and younger, at start of the RSV season, born between 32 weeks to 35 weeks of gestation with following risk factors:
      -Underlying conditions that predispose to respiratory complications
      -Smoke exposure
      -Daycare attendance
      -Multiple births
      -Number of young siblings
      -Anticipated cardiac surgery

   If your child is at risk, contact your physician about Synagis.

3. Dose and Administration: Synagis dose is calculated based on your child's weight and is administered by an intramuscular (e.g. injection into your baby's thigh) injection.

4. Duration: In order for the medication to provide the best benefit, Synagis should be administered before the RSV season begins and continuously administered for the entire duration of the season. Important note to remember is Synagis does not treat the infection; it provides a protective antibody against the virus for approximately one month. Therefore, your child should receive a Synagis injection once a month (every 28 to 30 days) to provide a continuous protection during the season. If the medication is not received in a timely manner, Synagis antibody in your child's blood may fall below a protective level, placing your child at risk for an infection. If your child misses an appointment for injection, contact your physician or pharmacist immediately.

5. Side Effects: Synagis is safe and generally very well tolerated. There may be little discomfort or itching at the site of an injection, as is the case for most injection, but this should not last long. Some babies may have fever, diarrhea, or stomach discomfort. However, benefits of Synagis may be much greater than possible side effects, if your child got severe RSV disease. Make sure you consult with your physician about Synagis therapy.

Why do RSV medications require specialized care from a specialty pharmacy?
Much like choosing a pediatric specialist to diagnose and treat RSV, it is equally as important to choose a specialty pharmacy for provision of your RSV medications needs. As opposed to a typical pharmacy which provides care to patients with every diagnosis, PharmaCare is experienced in providing pharmaceutical care to a select group of patients. This means that our pharmacists are experts in the drug therapy management of certain disease states including RSV. They have undergone rigorous and extensive education in managing complex medication regimens, and are able to address your injectable medication questions with authority and know-how. Also, PharmaCare pharmacists are available by phone around the clock, 7 days a week, 365 days a year, because your medication-related issues do not necessarily occur 9 to 5.

• Expert pharmacists who understand you, your medication and your needs.
• Individual support to help make it easier to take your injectable medications as prescribed.
• Home delivery of all your medications from one source - wherever you live, wherever you travel.
• 24-hour medication and adherence counseling is always available.
• Educational materials to help you make informed decisions about your healthcare.

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