Oral Ribavirin for the Treatment of Noninfluenza Respiratory Viral Infections: A Systematic Review.

Abstract

OBJECTIVE:

To review clinical outcomes data for patients treated with oral ribavirin for noninfluenza respiratory viral infections (NIRVIs).

DATA SOURCES:

MEDLINE, EMBASE, and PubMed Central (1972 to June 1, 2015) were queried with the following search term combinations: "Oral" AND "ribavirin" AND ("respiratory syncytial virus" OR "metapneumovirus" OR "parainfluenza" OR "coronavirus" OR "rhinovirus" OR "enterovirus" OR "adenovirus").

STUDY SELECTION AND DATA EXTRACTION:

Included studies must have characterized the clinical outcomes of a cohort of patients treated with oral ribavirin for symptomatic NIRVIs. Case reports and series with <5 cases, conference abstracts, and articles written in languages other than English were excluded.

DATA SYNTHESIS:

Of the 1256 unique reports, 15 met inclusion criteria: 12 retrospective, 3 prospective, and 3 comparative with untreated control groups. All studies except for 2 Middle East respiratory syndrome coronavirus (MERS-CoV) studies were in immunocompromised patients (9 malignancy/stem cell transplant, 4 lung transplant). The mortality rate ranged from 0% to 31% in malignancy/stem cell transplant recipients treated with oral ribavirin, and 1/108 (0.9%) ribavirin-treated lung transplant recipients died at 30 days. Three studies (one each for malignancy, lung transplant, and MERS-CoV) suggested a clinical outcomes benefit with oral ribavirin compared with supportive care alone; however, the nonrandomized design precludes efficacy determination. Hemolysis was the most common adverse reaction, occurring in 14% (54/375) of patients. Ribavirin was discontinued in 4% of patients secondary to adverse reactions.

CONCLUSIONS:

Oral ribavirin should be considered for the treatment of NIRVI in immunocompromised adults (malignancy/stem cell transplant or lung transplant) or adults with MERS-CoV.

• Authors: Alan E Gross, Michelle L Bryson
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 49 Issue 10 Pg. 1125-35 (Oct 2015) ISSN: 1542-6270 [Electronic] United States
• PMID: 26228937 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © The Author(s) 2015.

Chemical References

• Antiviral Agents
• Ribavirin

Topics

• Administration, Oral
• Antiviral Agents (therapeutic use)
• DNA Viruses
• Humans
• Immunocompromised Host
• RNA Viruses
• Respiratory Tract Infections (drug therapy, immunology, virology)
• Ribavirin (therapeutic use)
• Virus Diseases (drug therapy, immunology, virology)