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Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study.
Arabi Yaseen M.
Shalhoub Sarah.
Mandourah Yasser.
Al-Hameed Fahad.
Al-Omari Awad.
Al Qasim Eman.
Jose Jesna.
Alraddadi Basem.
Almotairi Abdullah.
Al Khatib Kasim.
Abdulmomen Ahmed.
Qushmaq Ismael.
Sindi Anees A.
Mady Ahmed.
Solaiman Othman.
Al-Raddadi Rajaa.
Maghrabi Khalid.
Ragab Ahmed.
Al Mekhlafi Ghaleb A.
Balkhy Hanan H.
Al Harthy Abdulrahman.
Kharaba Ayman.
Gramish Jawaher A.
Al-Aithan Abdulsalam M.
Al-Dawood Abdulaziz.
Merson Laura.
Hayden Frederick G.
Fowler Robert.
Acceso Abierto
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.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Appears in Collections:Artículos científicos

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