Obesity, the so-called killer of the 21st century, is a serious and pervading health problem in the industrialized world and developing countries. Its prevalence is on the rise, and its cost to ...health systems is astounding. The risk of death from all causes rises as body mass index (BMI) increases for both men and women in all age groups (1). For example, a 20-yr-old Caucasian male with a BMI greater than 45 kg/m2 is estimated to lose 13 yr of his life owing to obesity—a 17% reduction in life expectancy assuming a life expectancy of 78 yr (2).
Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infection, with a high global health burden. There are no effective treatments available. ALX-0171 is a ...novel trivalent Nanobody with antiviral properties against RSV. We aimed to assess the safety and antiviral activity of nebulised ALX-0171 in children admitted to hospital with RSV lower respiratory tract infection.
This double-blind, randomised, placebo-controlled, phase 2b trial was done in 50 hospital paediatric departments across 16 countries. Previously healthy children aged between 28 days to younger than 24 months who were admitted to hospital with RSV acute severe lower respiratory tract infection were randomly assigned in three sequential safety cohorts (3:1) to receive nebulised ALX-0171 (cohort 1 received 3 mg/kg, cohort 2 received 6 mg/kg, and cohort 3 received 9 mg/kg) or placebo once daily for 3 days using web-based randomisation in the sequential safety part (first block size 12, subsequently four). In a parallel part of the study, participants (cohort 4) were randomly assigned (parallel 1:1:1:1) to receive nebulised ALX-0171 3 mg/kg, 6 mg/kg, 9 mg/kg, or placebo (blocks of eight by restricted randomisation). Study drug masking was by two consecutive nebulisations (each either ALX-0171 or placebo) depending on assigned treatment group. The primary outcome was to evaluate time for the RSV viral load to drop to below quantifiable limit, measured by plaque assay on mid-turbinate nasal swabs. Safety, clinical efficacy, pharmacokinetics, viral load by RT-qPCR, and immunogenicity were secondary outcomes. Analysis, including of the primary outcome, was by modified intention to treat (participants receiving at least one dose of study drug as assigned), and safety was assessed in all children who received at least one administration of study drug, as treated. This trial is registered with EudraCT, 2016-001651-49.
Between Jan 10, 2017, and April 26, 2018, 175 children (median age 4·8 months IQR 2·0-10·8), received at least one dose of study drug (45 received 3 mg/kg of ALX-0171, 43 received 6 mg/kg of ALX-0171, 45 received 9 mg/kg of ALX-0171, and 42 received placebo; the modified intention-to-treat population) commencing at a mean 3·3 days (SD 1·1) from symptom onset. Median time for the viral load to drop to below quantifiable limit on plaque assay was significantly faster for the 3 mg/kg group (median 14·2 h IQR 5·0-28·0), 6 mg/kg group (5·1 h 4·7-28·5), and 9 mg/kg group (5·1 h 4·6-5·9) than the placebo group (46·1 h 25·2-116·7; hazard ratio HR all ALX-0171 groups vs placebo 2·6 1·7-3·9; p<0·0001). Median time for the viral load to drop below quantification limit with RT-qPCR was 95·9 h (IQR 26·7 to not estimable) for the placebo group (n=35) versus 49·4 h (25·1 to 351·4) for all ALX-0171 groups (n=118). Clinical outcomes were not improved by ALX-0171 compared with placebo, with no difference in time to clinical response (oxygen saturation >92% for 4 h in room air and adequate oral feeding) in ALX-0171 groups and the placebo group (median 43·8 h IQR 21·7-68·5 vs 47·9 h 22·5-76·4; HR 1·1 95% CI 0·8-1·6) or change in the global severity score from baseline to 5 h post-dose on day 2 (-4 IQR -6 to -2 vs -4 -6 to -1; difference in least-squares mean -0·45 95% CI -1·39 to 0·49). Serum concentrations of ALX-0171 on day 2 exceeded the concentration estimated to give full RSV neutralisation in the lung at 6 mg/kg and 9 mg/kg doses. Treatment-emergent antidrug antibodies were detected at day 14 in 46 (34%) of 135 patients who received ALX-0171 and ten (26%) of 39 patients who received placebo. Serious adverse events were reported in five (13%) of 40 children in the placebo group and ten (7%) of 135 children in all ALX-0171 groups, leading to study drug discontinuation in three children (two in the 3 mg/kg group and one in the 6 mg/kg group). 13 of 15 serious adverse events (three of four in the 3 mg/kg group, two of three in the 6 mg/kg group, three of three in the 9 mg/kg group, and five of five in the placebo group) were related to worsening respiratory status, and none were considered to be related to the study drug.
Antivirals against RSV might be unable to improve clinical course once RSV lower respiratory tract infection is established. Future studies of RSV antivirals should focus on earlier intervention and more precise measurement of objective outcomes before the onset of significant lower respiratory tract inflammation.
Ablynx, a Sanofi Company.
This study examined whether parental monitoring mediated the relationship between community violence exposure and a spectrum of behaviors such as recidivism, risky sex, and drug use among youth with ...a history of being detained. It also explored whether risk pathways differed by gender. Adolescents (n = 550) who were detained or previously detained were recruited from eight regional detention facilities in Georgia. Audio computer-assisted self-interviewing technology was used to assess demographic factors (i.e., age, race, and socioeconomic status), risky sex, drug use, and recidivism prior to being detained. Major findings indicated direct relationships between community violence exposures and risky sex and drug use in the 2 months prior to being detained. Findings also indicated that parental monitoring mediated these relationships for both adolescent males and females. These findings document that parental monitoring is an important element even for troubled youth across a broad spectrum of risk factors. Consequently, it is recommended that intervention programs examine the differential effects of monitoring behaviors by a variety of groups such as parental figures, teachers, and peer mentors.
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