Ribavirin is not effective against Crimean–Congo hemorrhagic fever: observations from the Turkish experience

Ceylan, Bahadır; Calıca, Aylin; Ak, Öznur; Akkoyunlu, Yasemin; Turhan, Vedat

doi:10.1016/j.ijid.2013.02.030

Cited by 28 publications

(20 citation statements)

References 22 publications

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“…Ribavirin has adverse effects, and, as well as the questions about its efficacy, clinicians debate whether or not to risk using the drug (Ceylan 2013; Oflaz 2015). Some of the adverse effects include risks of haemolysis, arrhythmia, bone marrow suppression, and deranged liver function (EMA 2015).…”

Section: Introductionmentioning

confidence: 99%

Ribavirin for treating Crimean Congo haemorrhagic fever

Johnson

Maayan

Mills

et al. 2018

Cochrane Database of Systematic Reviews

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BackgroundCrimean Congo haemorrhagic fever (CCHF) is a tick-borne disease that occurs in parts of Asia, Europe and Africa. Since 2000 the infection has caused epidemics in Turkey, Iran, Russia, Uganda and Pakistan. Good-quality general supportive medical care helps reduce mortality. There is uncertainty and controversy about treating CCHF with the antiviral drug ribavirin.ObjectivesTo assess the effects of ribavirin for treating people with Crimean Congo haemorrhagic fever.Search methodsWe searched the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (OVID); Science Citation Index-Expanded, Social Sciences Citation index, conference proceedings (Web of Science); and CINAHL (EBSCOHost). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for trials in progress. We conducted all searches up to 16 October 2017. We also contacted experts in the field and obtained further studies from these sources.Selection criteriaWe evaluated studies assessing the use of ribavirin in people with suspected or confirmed Crimean Congo haemorrhagic fever. We included randomised control trials (RCTs); non-randomised studies (NRSs) that included more than 10 participants designed as cohort studies with comparators; and case-control studies.Data collection and analysisTwo review authors assessed eligibility, risk of bias, and extracted data. For non-randomized studies we used the ROBINS-I tool to assess risk of bias. The main effects analysis included all studies where we judged the risk of bias to be low, moderate or high. We summarized dichotomous outcomes using risk ratios (RRs) and continuous outcomes using mean differences (MDs), and used meta-analyses where appropriate. We carried out a subsidiary appraisal and analysis of studies with critical risk of bias for the primary outcome, as these are often cited to support using ribavirin.Main resultsFor the main effects analysis, five studies met our inclusion criteria: one RCT with 136 participants and four non-randomized studies with 612 participants. We excluded 18 non-randomized studies with critical risk of bias, where none had attempted to control for confounding.We do not know if ribavirin reduces mortality (1 RCT; RR 1.13, 95% confidence interval (CI) 0.29 to 4.32; 136 participants; very low-certainty evidence; 3 non-randomized studies; RR 0.72, 95% CI 0.41 to 1.28; 549 participants; very low-certainty evidence). We do not know if ribavirin reduces the length of stay in hospital (1 RCT: mean difference (MD) 0.70 days, 95% CI -0.39 to 1.79; 136 participants; and 1 non-randomized study: MD -0.80, 95% CI -2.70 to 1.10; 50 participants; very low-certainty evidence). We do not know if it reduces the risk of patients needing platelet transfusions (1 RCT: RR 1.23, 95% CI 0.77 to 1.96; 136 participants; very low-certainty evidence). For adverse effects (including haemolytic anaemia and a need to discontinue treatment), we do not know whether there is a...

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Section: Introductionmentioning

confidence: 99%

Ribavirin for treating Crimean Congo haemorrhagic fever

Johnson

Maayan

Mills

et al. 2018

Cochrane Database of Systematic Reviews

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“…Cabe destacar que los estudios incluidos para la realización de sendos metaanálisis eran estudios prospectivos no aleatorizados ni enmascarados, a excepción del ensayo clínico citado 30 , y además incluyeron un número reducido de trabajos 28,29 . De forma global, la mortalidad en pacientes que reciben ribavirina es del 2-9% frente al 5-11% de aquellos que no la reciben 31 . La OMS recomienda el uso de ribavirina para la FHCC, aunque la recomendación con mayor respaldo sea para la fiebre de Lassa 32 .…”

Section: Antiviralesunclassified

Manejo terapéutico de la fiebre hemorrágica de Crimea-Congo

Calle-Prieto¹,

Martín-Quirós²,

Trigo³

et al. 2018

Enfermedades Infecciosas y Microbiología Clínica

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Crimean-Congo haemorrhagic fever has been reported in more than 30 countries in Africa, Asia, the Middle East and Eastern Europe, with an increasing incidence in recent years, especially in Europe. Because no specific treatments have demonstrated efficacy, supportive treatment is essential, as well as the provision of a centre with the appropriate means to guarantee the safety of its healthcare professionals. Laboratory monitoring of thrombocytopenia, severe coagulopathy or liver failure is of critical importance. Patients with Crimean-Congo haemorrhagic fever should be admitted to High Level Isolation Units where appropriate biocontainment procedures can prevent nosocomial transmission through infected fluids or accidents with contaminated material. In case of high-risk exposures, early administration of ribavirin should be considered.

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“…The Perspective ''Ribavirin is not effective against CrimeanCongo hemorrhagic fever: observations from the Turkish experience'' by Ceylan et al, 1 published in this Journal, reflected the 'against' side of a debate performed in 'for and against', or 'pro et contra' style that took place in Istanbul in May 2012. The debate concerned the use of ribavirin in Crimean-Congo hemorrhagic fever (CCHF).…”

mentioning

confidence: 99%

Evidence supports ribavirin use in Crimean-Congo hemorrhagic fever

Ergönül

2014

International Journal of Infectious Diseases

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Ribavirin is not effective against Crimean–Congo hemorrhagic fever: observations from the Turkish experience

Cited by 28 publications

References 22 publications

Ribavirin for treating Crimean Congo haemorrhagic fever

Ribavirin for treating Crimean Congo haemorrhagic fever

Manejo terapéutico de la fiebre hemorrágica de Crimea-Congo

Evidence supports ribavirin use in Crimean-Congo hemorrhagic fever

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