Clinical Outcomes of Paramyxovirus Infections in Lung Transplant Recipients Treated With Oral Ribavirin: A Two-Center Case Series

Abstract

Objectives: Paramyxoviruses contribute to morbidity and mortality after lung transplant and are associated with bronchiolitis obliterans syndrome. Oral ribavirin has been used off-label for treatment of paramyxoviruses in immunosuppressed patients; however, data supporting its use for this purpose are lacking.

Evaluation of 10 years of parainfluenza virus, human metapneumovirus, and respiratory syncytial virus infections in lung transplant recipients

“…This is analogous to other reports of mild infection. Furthermore, although successful treatment of hMPV and PIV has been described, 5,6,21,24,38 no consensus exists whether to treat these infections with ribavirin.…”

“…In contrast, high CLAD incidences up to 20% have also been described in LTRs who received systemic ribavirin for RSV or hMPV 4 . Furthermore, although successful treatment of hMPV and PIV has been described, 5,6,21,24,38 no consensus exists whether to treat these infections with ribavirin.…”

“…[18][19][20] Thus far, a limited number of small cohort studies have reported successful outcomes with ribavirin treatment for PV/PMV infections in LTR. 2, [21][22][23][24] However, the effectiveness remains a matter of debate, as data from randomized studies are lacking. In this retrospective cohort study we aim to evaluate the course of lung function and incidence of new-onset or progression of CLAD in LTR with a PV/PMV infection, with or without ribavirin treatment.…”

“…Ribavirin is a nucleoside analogue antiviral that is currently only registered as inhalation therapy for severe RSV infection and is used off label (increasingly in oral form) based on its in vitro activity against hMPV and PIV 1‐4 18‐20 . Thus far, a limited number of small cohort studies have reported successful outcomes with ribavirin treatment for PV/PMV infections in LTR 2,21‐24 . However, the effectiveness remains a matter of debate, as data from randomized studies are lacking.…”

Ribavirin shows antiviral activity against SARS-CoV-2 and downregulates the activity of TMPRSS2 and the expression of ACE2 In Vitro

“…It is well-known that ribavirin molecule has different antiviral mechanisms of action against different viruses [5]. In one these mechanisms, ribavirin monophosphate can potently inhibit guanosine derivatives (eg guanosine triphosphate [GTP]) and reduce nucleotide residues resulting in antiviral effect, especially in studies with respiratory syncytial virus (RSV), yellow fever virus and paramyxovirus [6][7][8][9].…”