A retrospective analysis of clinical efficacy of ribavirin in adults hospitalized with severe COVID-19

Abstract

Introduction Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. Methods A total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay. Results 68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement ( P = 0.48, HR = 0.88, 95% CI = 0.63-1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay. Conclusions In hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.

Current utilization of interferon alpha for the treatment of coronavirus disease 2019: A comprehensive review

“… [17] , [86] , [88] , [102] , [122] , [130] Studies reporting inefficacy of IFNα or delayed hospital discharge also reported a longer time from the onset of symptoms to hospital admission. [46] , [69] Based on these studies, we believe that the magic number is five. Treatment initiated within five days of the onset of symptoms may be considered as early treatment, which confers a better treatment response and prognosis.…”

“…A total of 178 studies were found to have reported IFNα treatment for COVID-19 (Supplemental 2). [13] , [17] , [19] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , …”

“…Patients with severe COVID-19 disease did not seem to benefit from IFNα treatment. [46] , [188] , [195] On the contrary, a case report from the UAE suggested clinical benefits of IFNα treatment in severe patients, in which three cases received subcutaneous injections of pegylated IFNα-2a following clinical deterioration and oxygen support. [42] The timing of treatment initiation of the three reported cases were 3, 7, and 11 days after hospital admission.…”

“…A retrospective cohort study investigating 208 severe patients showed that there were no differences in clinical improvement, nucleic acid negative conversion, length of hospitalization, survival time, or mortality between the 29 patients who received IFNα inhalation and ribavirin and the 179 patients who received ribavirin alone. [46] Furthermore, a larger retrospective study investigating 1,074 non-severe and 963 severe patients found that IFNα inhalation in combination with ribavirin was associated with higher risks of hospital stay over 15 days. [69] These studies suggest possible drug-drug interactions between IFNα and ribavirin.…”

Could Histamine H1 Receptor Antagonists Be Used for Treating COVID-19?

“…Recently, ribavirin was recommended to be used with interferon α or lopinavir-ritonavir for COVID-19 treatment. However, the effects of ribavirin on COVID-19 are controversial and need to be further confirmed [ 35 ]. Recently, a molecular docking result indicated that sofosbuvir may inhibit RNA-dependent RNA polymerase (RdRP) of SARS-CoV-2 [ 36 ].…”