Placebo-Controlled, Double-Blind Trial of Intravenous Ribavirin for the Treatment of Hantavirus Cardiopulmonary Syndrome in North America

Mertz, Grégory; Miedzinski, Lil; Goade, Diane; Pavia, Andrew T.; Hjelle, Brian; Hansbarger, Clark; Levy, Howard; Koster, Frederick; Baum, Kenneth F.; Lindemulder, A.; Wang, W.; Riser, Laura; Fernández, H.; Whitley, Richard J.

doi:10.1086/425007

Cited by 151 publications

(98 citation statements)

References 6 publications

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“…S1) [2,3,5,6,11,14,15], and they were divided into four groups according to whether they were investigating new or old-world hantavirus infections involving humans or animals. A total of 506 clinically similar cases of HPS (124 cases) [2,11,14,15] or FHSR (382) were represented [3,5,6]. In the Fig.…”

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confidence: 99%

“…In the meta-analysis related to the hantaviruses that causes HPS, only a study was a randomized clinical trial [11], and three were prospective cohort [2,14,15]. As for the effectiveness of ribavirin for the treatment of HPS-like disease in animal, this group presented reduction in mortality, i.e., in the treatment group, the survival of this population was higher compared to the control group (RR 0.05, 95 % CI 0.01-0.34, I 2 = 0 %).…”

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confidence: 99%

“…Four studies described ribavirin treatment in vivo for etiologic agents of HPS [2,11,14,15], and the remainder [3,5,6] evaluated the effects of this drug for etiologic agents of HFRS. A total of 506 participants were recruited, and of these 177 died, regardless of whether ribavirin was used.…”

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confidence: 99%

“…In our quantitative meta-analysis of studies involving ribavirin treatment in humans with HPS, the results were contrary to the studies using animals, i.e., there was no significant difference between the treated and untreated groups. Therefore, the effects of this drug in humans with HPS remain unclear for the following reasons [2,11]: (1) the small number of existing studies, which involved relatively small recruited populations with only 1/3 of the total patients with HFRS; (2) an inability to follow the effects of antiviral therapy due to the severity of disease; and (3) the difficulty in recruiting participants. Significantly, in severe cases of HFRS, mortality usually occurs one week after admission to the hospital, while in HPS, this outcome is observed on average on the third day after hospitalization.…”

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confidence: 99%

“…In view of this, the studies included in the meta-analysis had more patients in the cardiopulmonary phase [2,11]. Given the rapid progression of the disease to death at this stage, there seems a relatively short amount of time to evaluate the benefits of ribavirin.…”

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confidence: 99%

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Effectiveness of the ribavirin in treatment of hantavirus infections in the Americas and Eurasia: a meta-analysis

et al. 2014

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Hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) are transmitted to humans through infection with the old-and new-world hantaviruses, respectively. Together these diseases affect tens of thousands of people every year, and no specific treatment is available. To investigate whether ribavirin treatment for hantaviruses infections decreases disease severity, we conducted a meta-analysis involving human and animal studies. After defining the research protocol and criteria for inclusion/exclusion, we identified seven studies. We found that in groups with HPS who were treated with ribavirin, there was no significant reduction in mortality (RR 0.99, 95 % CI 0.60-1.61, I 2 = 0 %). On the other hand, for animal group with HPS-like disease, there was significant increase in survival (RR 0.05, 95 % CI 0.01-0.34, I 2 = 0 %). For animal group infected with the old-world hantaviruses, treated with ribavirin, there was a statistically significant increase in survival (RR 0.56, 95 % CI 0.42-0.76, I 2 = 64 %). Similarly, for humans with HFRS treated, there was increase in survival (RR 0.28, 95 % CI 0.08-1), although only a study exist. Our metaanalysis provides data that should be interpreted with caution, partly due to the limited number of studies available. Additionally, the results of the application of ribavirin in the population with HPS could not be determined, particularly in patients in the end stage of this disease.

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