Journal Article

Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome

Abdulmomen, Ahmed, Gramish, Jawaher A., Al-Omari, Awad, Sindi, Anees A., Maghrabi, Khalid, Al-Hameed, Fahad, Qushmaq, Ismael, Balkhy, Hanan H., Mandourah, Yasser, Ragab, Ahmed, Jose, Jesna, Solaiman, Othman, Alraddadi, Basem, Al Harthy, Abdulrahman, Al-Dawood, Abdulaziz, Al-Raddadi, Rajaa, Al Mekhlafi, Ghaleb A., Fowler, Robert, Hayden, Frederick G., Al Qasim, Eman, Merson, Laura, Mady, Ahmed, Almotairi, Abdullah, Kharaba, Ayman, Al-Aithan, Abdulsalam M., Shalhoub, Sarah, Arabi, Yaseen M., Al Khatib, Kasim

2020

Overview

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-α2a, rIFN-α2b, or rIFN-β1a; none received rIFN-β1b). 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-α2a, rIFN-α2b, or rIFN-β1a) 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. In this observational study accounting for baseline and time-varying confounders, ribavirin and recombinant interferon (rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.

• Publisher: Oxford University Press
• Subject: Aged / and Commentaries / Antiviral Agents - therapeutic use / ARTICLES AND COMMENTARIES / Coronavirus Infections - mortality / Coronavirus Infections - therapy / Critical Illness / Female / Humans / Intensive Care Units / Interferon alpha-2 - therapeutic use / Male / Middle Aged / Middle East Respiratory Syndrome Coronavirus / Pneumonia, Viral - drug therapy / Retrospective Studies / Ribavirin - therapeutic use / RNA, Viral - blood / Saudi Arabia / Treatment Outcome