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- Title
Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study.
- Authors
Arabi, Yaseen M; Shalhoub, Sarah; Mandourah, Yasser; Al-Hameed, Fahad; Al-Omari, Awad; Qasim, Eman Al; Jose, Jesna; Alraddadi, Basem; Almotairi, Abdullah; Khatib, Kasim Al; Abdulmomen, Ahmed; Qushmaq, Ismael; Sindi, Anees A; Mady, Ahmed; Solaiman, Othman; Al-Raddadi, Rajaa; Maghrabi, Khalid; Ragab, Ahmed; Mekhlafi, Ghaleb A Al; Balkhy, Hanan H
- 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.
- Subjects
THERAPEUTIC use of interferons; CRITICAL care medicine; CRITICALLY ill; MEDICAL cooperation; SCIENTIFIC observation; PATIENTS; RESEARCH; RIBAVIRIN; MIDDLE East respiratory syndrome
- Publication
Clinical Infectious Diseases, 2020, Vol 70, Issue 9, p1837
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciz544