Respiratory syncytial virus antiviral agents

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Abstract
Control of respiratory syncytial virus (RSV) disease has remained an elusive goal for over four decades. Ribavirin (Virazole®), licensed as an RSV therapeutic over a decade ago, has been viewed with decreasing enthusiasm by clinicians but no other therapeutic regimen has emerged as a preferred alternative. Passive prophylaxis using polyclonal or monoclonal immunoglobulins has proven safe and effective, but high costs have generally limited utilisation to high-risk infants leaving the larger infant population, as well as several subpopulations of high-risk children and adults, without a widely-applicable form of prophylaxis. Many classes of anti-RSV compounds have been identified, acting at various stages of the viral replication cycle. Most have shown antiviral activity only in vitro, but even those showing in vivo activity have failed to show a significant clinical therapeutic effect. While insufficiently potent antiviral activity might explain this phenomenon, a more likely explanation is that an effective therapeutic approach will require two concomitant elements, one to eliminate infectious virus, the other to reverse the cascade of host inflammatory processes initiated by infection.

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