TY - JOUR
T1 - Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients
T2 - a systematic review and meta-analysis
AU - Manothummetha, Kasama
AU - Mongkolkaew, Thanuthong
AU - Tovichayathamrong, Punyot
AU - Boonyawairote, Rabhas
AU - Meejun, Tanaporn
AU - Srisurapanont, Karan
AU - Phongkhun, Kasidis
AU - Sanguankeo, Anawin
AU - Torvorapanit, Pattama
AU - Moonla, Chatphatai
AU - Plongla, Rongpong
AU - Kates, Olivia S.
AU - Avery, Robin K.
AU - Nematollahi, Saman
AU - Permpalung, Nitipong
N1 - Publisher Copyright:
© 2023 European Society of Clinical Microbiology and Infectious Diseases
PY - 2023/10
Y1 - 2023/10
N2 - Background: Ribavirin use for respiratory syncytial virus (RSV) infection in patients with haematologic malignancies (HM) and haematopoietic stem cell transplant (HSCT) recipients remains controversial. Objectives: To summarize the current evidence of ribavirin treatment in association with mortality and progression to lower respiratory tract infection (LRTI) among patients with HM/HSCT with RSV infection. Data sources: MEDLINE, Embase, and the Institute for Scientific Information Web of Science. Study eligibility criteria: Randomized controlled trials and observational studies investigating the effects of ribavirin, compared with treatment without ribavirin, for RSV infection. Participants: Patients with HM/HSCT. Interventions: Ribavirin versus no ribavirin. Assessment of risk of bias: The risk of bias in non-randomized studies of exposure (ROBIN-E). Methods of data synthesis: The random-effects model was used to calculate the pooled OR (pOR) with 95% CI for the pooled effect estimates of ribavirin benefits. Grading of recommendation assessment, development, and evaluation was used to evaluate the certainty of evidence. Results: One randomized controlled trial and 14 observational studies were included, representing 1125 patients with HM/HSCT. Ribavirin use was not associated with lower all-cause or RSV-associated mortality with pORs [95% CI] of 0.81 [0.40, 1.66], I2 = 55% (low certainty of evidence) and 0.48 [0.11, 2.15], I2 = 64% (very low certainty of evidence), respectively. In subgroup analyses, ribavirin use was associated with lower mortality in patients with HM/HSCT with LRTI with pOR [95% CI] of 0.19 [0.07, 0.51], I2 = 0% (moderate certainty of evidence). In subgroup analyses among studies providing adjusted OR, ribavirin use was associated with lower all-cause mortality with pOR of 0.41 [0.23, 0.74], I2 = 0% (moderate certainty of evidence). In addition, aerosolized ribavirin was associated with lower progression to LRTI with pOR [95% CI] of 0.27 [0.09, 0.80], I2 = 71% (low certainty of evidence). Conclusions: Ribavirin may be a reasonable option to treat RSV in patients with HM/HSCT in the absence of other effective antiviral agents.
AB - Background: Ribavirin use for respiratory syncytial virus (RSV) infection in patients with haematologic malignancies (HM) and haematopoietic stem cell transplant (HSCT) recipients remains controversial. Objectives: To summarize the current evidence of ribavirin treatment in association with mortality and progression to lower respiratory tract infection (LRTI) among patients with HM/HSCT with RSV infection. Data sources: MEDLINE, Embase, and the Institute for Scientific Information Web of Science. Study eligibility criteria: Randomized controlled trials and observational studies investigating the effects of ribavirin, compared with treatment without ribavirin, for RSV infection. Participants: Patients with HM/HSCT. Interventions: Ribavirin versus no ribavirin. Assessment of risk of bias: The risk of bias in non-randomized studies of exposure (ROBIN-E). Methods of data synthesis: The random-effects model was used to calculate the pooled OR (pOR) with 95% CI for the pooled effect estimates of ribavirin benefits. Grading of recommendation assessment, development, and evaluation was used to evaluate the certainty of evidence. Results: One randomized controlled trial and 14 observational studies were included, representing 1125 patients with HM/HSCT. Ribavirin use was not associated with lower all-cause or RSV-associated mortality with pORs [95% CI] of 0.81 [0.40, 1.66], I2 = 55% (low certainty of evidence) and 0.48 [0.11, 2.15], I2 = 64% (very low certainty of evidence), respectively. In subgroup analyses, ribavirin use was associated with lower mortality in patients with HM/HSCT with LRTI with pOR [95% CI] of 0.19 [0.07, 0.51], I2 = 0% (moderate certainty of evidence). In subgroup analyses among studies providing adjusted OR, ribavirin use was associated with lower all-cause mortality with pOR of 0.41 [0.23, 0.74], I2 = 0% (moderate certainty of evidence). In addition, aerosolized ribavirin was associated with lower progression to LRTI with pOR [95% CI] of 0.27 [0.09, 0.80], I2 = 71% (low certainty of evidence). Conclusions: Ribavirin may be a reasonable option to treat RSV in patients with HM/HSCT in the absence of other effective antiviral agents.
KW - Haematologic malignancy
KW - Haematopoietic stem cell transplant
KW - RSV
KW - Respiratory syncytial virus
KW - Ribavirin
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U2 - 10.1016/j.cmi.2023.04.021
DO - 10.1016/j.cmi.2023.04.021
M3 - Review article
C2 - 37116860
AN - SCOPUS:85159673021
SN - 1198-743X
VL - 29
SP - 1272
EP - 1279
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 10
ER -