Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study
Open Access
- 1 May 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 70 (9), 1837-1844
- https://doi.org/10.1093/cid/ciz544
Abstract
Background: The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. Methods: This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. Results: Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-alpha 2a, rIFN-alpha 2b, or rIFN-beta 1a; none received rIFN-beta 1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73-1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30-1.44]; P = .29). Conclusions: In this observational study, RBV/rIFN (RBV and/or rIFN-alpha 2a, rIFN-alpha 2b, or rIFN-beta 1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.Keywords
Funding Information
- National Institutes of Health
This publication has 23 references indexed in Scilit:
- Middle East Respiratory SyndromeNew England Journal of Medicine, 2017
- Treatment outcomes for patients with Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi ArabiaBMC Infectious Diseases, 2016
- IFN-α2a or IFN-β1a in combination with ribavirin to treat Middle East respiratory syndrome coronavirus pneumonia: a retrospective studyJournal of Antimicrobial Chemotherapy, 2015
- Ribavirin and Interferon-α2b as Primary and Preventive Treatment for Middle East Respiratory Syndrome Coronavirus: A Preliminary Report of Two CasesAntiviral Therapy, 2015
- Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort studyThe Lancet Infectious Diseases, 2014
- Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational studyInternational Journal of Infectious Diseases, 2014
- Interferon-β and mycophenolic acid are potent inhibitors of Middle East respiratory syndrome coronavirus in cell-based assaysJournal of General Virology, 2014
- Therapeutic Options for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) – possible lessons from a systematic review of SARS-CoV therapyInternational Journal of Infectious Diseases, 2013
- Treatment with interferon-α2b and ribavirin improves outcome in MERS-CoV–infected rhesus macaquesNature Medicine, 2013
- Inhibition of novel β coronavirus replication by a combination of interferon-α2b and ribavirinScientific Reports, 2013