Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study

Abstract

Background The objective of this study was to evaluate the effect of ribavirin and recombinant interferon (RBV/rIFN) therapy on the outcomes of critically ill patients with Middle East respiratory syndrome (MERS), accounting for time-varying confounders. Methods This is a retrospective cohort study of critically ill patients with laboratory-confirmed MERS from 14 hospitals in Saudi Arabia diagnosed between September 2012 and January 2018. We evaluated the association of RBV/rIFN with 90-day mortality and MERS coronavirus (MERS-CoV) RNA clearance using marginal structural modeling to account for baseline and time-varying confounders. Results Of 349 MERS patients, 144 (41.3%) patients received RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a; none received rIFN-β1b). RBV/rIFN was initiated at a median of 2 days (Q1, Q3: 1, 3 days) from intensive care unit admission. Crude 90-day mortality was higher in patients with RBV/rIFN compared to no RBV/rIFN (106/144 [73.6%] vs 126/205 [61.5%]; P = .02]. After adjusting for baseline and time-varying confounders using a marginal structural model, RBV/rIFN was not associated with changes in 90-day mortality (adjusted odds ratio, 1.03 [95% confidence interval {CI}, .73–1.44]; P = .87) or with more rapid MERS-CoV RNA clearance (adjusted hazard ratio, 0.65 [95% CI, .30–1.44]; P = .29). Conclusions In this observational study, RBV/rIFN (RBV and/or rIFN-α2a, rIFN-α2b, or rIFN-β1a) therapy was commonly used in critically ill MERS patients but was not associated with reduction in 90-day mortality or in faster MERS-CoV RNA clearance.

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“…Currently, COVID-19 has no particularly effective treatment. The effect of antiviral therapy is still controversial [25]. Here we tried to treat COVID-19 patients with arbidol.…”

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“…In view of the high amount of cytokines induced by SARS-CoV, MERS-CoV and SARS-CoV-2 infections [9], corticosteroids were frequently used for the treatment of patients with severe illness, the reduction of the inflammatory-induced lung injury being the expected benefit. However, current evidence suggests that corticosteroids did not have an effect on mortality, but rather delayed viral clearance [10]. Moreover, the increase in the viral load and viremia argue against their use.…”

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“…Interferon (IFN) is a type of glycoprotein that triggers the antiviral immune response in patients infected with MERS [82] . In animal models, IFN inhibits the replication of SARS-CoV and MERS-CoV.…”