Current practices for treatment of respiratory syncytial virus and other non‐influenza respiratory viruses in high‐risk patient populations: a survey of institutions in the Midwestern Respiratory Virus Collaborative

Abstract

Treatment of RSV in immunocompromised patients varied greatly. While most centers treat LRTI, treatment of URTI was variable. No consensus was found regarding the use of oral versus inhaled RBV, or the use of IVIG. The presence of such heterogeneity demonstrates the need for further studies defining optimal treatment of RSV in immunocompromised hosts.

Advances in respiratory virus therapeutics – A meeting report from the 6th isirv Antiviral Group conference

“…Aerosolized ribavirin was first marketed in 1980 for the treatment of RSV in children, but to date there is still no convincing evidence as to its clinical benefit or antiviral effect in human populations. In special populations including the immunocompromised (Beaird et al, 2016), it is often delivered in the oral or IV form which generates drug concentrations at sites of RSV replication far lower than needed to inhibit viral replication . Several potent and selective small molecule antiviral compounds have been identified and have progressed to clinical trials.…”

Viral Pneumonia in Patients with Hematopoietic Cell Transplantation and Hematologic Malignancies

“…66,104 However, because of recent increases in the cost of this formulation, the use of systemic (oral or parenteral) ribavirin is increasing despite a paucity of evidence to support this practice. 102,105,106 There are a few noteworthy agents with novel mechanisms of action that are currently in trial: GS5806, an oral RSV entry inhibitor; and ALS8176, a nucleoside RSV polymerase inhibitor. 107,108 Finally, pneumonia caused by RSV has been associated with a significant airflow decline by 1 year posttransplant, an important long-term sequela of this common infection.…”

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

“…[3][4][5] Although there is consensus that treatment of RSV is essential in the lung transplant population, there remains a lack of data to conclude the best mode of therapy, and treatment of other paramyxoviruses is even less well studied. 6,7 Ribavirin is a synthetic nucleoside analog with in vivo and in vitro evidence supporting its activity against a range of viruses, including RSV, parainfluenza, and HMV. [8][9][10][11][12][13] Prior case series have described bone marrow and lung transplant patients infected by RSV who used inhaled, intravenous, or oral ribavirin with or without the addition of corticosteroids, intravenous immunoglobulin, and palivizumab.…”

“…However, these studies have been limited by small sample sizes, lack of control groups, and single-center retrospective study designs. [5][6][7][8]14 Intravenous ribavirin is not commercially available in the United States, and the clinical utility of inhaled ribavirin is limited for multiple reasons, including its high cost, its need for a negative pressure room due to potential toxicity to health care providers as it is a known teratogen, the potential for bronchospasm, and its ability to obstruct the ventilator circuit. 5,8 Oral ribavirin is well tolerated, is a lower cost medication approved for the treatment of hepatitis C virus, and is increasingly being utilized for the treatment of RSV infections in lung transplant recipients.…”