Oral ribavirin for treatment of respiratory syncitial virus and parainfluenza 3 virus infections post allogeneic haematopoietic stem cell transplantation

Abstract

The prognosis for patients with respiratory syncytial virus (RSV) or parainfluenza virus type 3 (PIV3) respiratory tract infection post allogeneic haematopoietic progenitor cell transplant (HPCT) is historically poor. The use of oral ribavirin (RBV) has not been widely studied in this patient population. We examined the outcomes of 15 consecutive patients (RSV, n ¼ 13 and PIV3, n ¼ 2) treated with oral RBV post HPCT. Oral RBV was commenced at a starting dose of 10 mg/kg/day, increasing to a maximum dose of 60 mg/kg/day depending on response and tolerance. At diagnosis, seven patients had upper respiratory tract infection (URTI) and eight had lower respiratory tract infection (LRTI). The starting RBV dose of 10 mg/kg/day did not prevent the progression of URTI to LRTI in any patient. However, with dose escalation, six of the seven patients responded to RBV therapy and survived their infective episode. Of the eight patients presenting with LRTI, six patients survived their infection, again after dose escalation of RBV. There was no dose-limiting toxicity seen in any patient. Our results indicate that oral RBV has clinical efficacy in the treatment of RSV/PIV3 infection post HPCT. However, a starting dose of 10 mg/kg/day appears ineffective; we recommend a starting dose of 20 mg/kg/day in this patient group.

Oral ribavirin for paramyxovirus infection after alemtuzumab‐containing reduced‐intensity conditioning HCT regimen

“…The current case series demonstrates acceptable tolerability in three children and one young adult with lower respiratory tract infection. The most common side effects reported with oral ribavirin include hemolytic anemia and elevation of transaminases . The most common adverse effect in our case series was hemolytic anemia, which necessitated transfusion in 2 patients.…”

“…Although data regarding the concentration of systemic ribavirin in lung tissue or BAL fluid are lacking, a retrospective study detected no significant differences in 6‐month outcomes between oral and inhaled ribavirin therapy for RSV infection after lung transplantation . Since oral ribavirin can be continued in an outpatient setting, it is also associated with reduced length of hospital stays when compared with the aerosolized form …”

Respiratory syncytial virus in immunocompromised patients in a paediatric hospital: 5 years’ experience

“…12 However, it has been hypothesised that oral administration may not prevent progression of the infection, and consequently suggested that treatment starts with a high dose that is later escalated according to how the patient responds. 13 The appropriate duration of treatment has yet to be established, although most groups continue pharmacological therapy until the virus is cleared. The combination of antiviral agents with the monoclonal antibody palivizumab is safe, well-tolerated by the patient, and has shown high efficacy in association with symptom resolution and viral clearance.…”

Presentation of Severe Combined Immunodeficiency with Respiratory Syncytial Virus and Pneumocystis Co-infection

“…8 SCID is usually fatal without restoration of immune function by BMT or gene therapy. 14,15 P. jiroveci is an opportunistic pathogen which can cause infection and death in children with patients with severe T-cell immunodeficiencies. 9 Treatment of RSV infection in immunocompromised patients includes RBV, palivizumab and IVIG.…”