Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis
12
Issued Date
2023-01-01
Resource Type
ISSN
1198743X
eISSN
14690691
Scopus ID
2-s2.0-85159673021
Pubmed ID
37116860
Journal Title
Clinical Microbiology and Infection
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Microbiology and Infection (2023)
Suggested Citation
Manothummetha K., Mongkolkaew T., Tovichayathamrong P., Boonyawairote R., Meejun T., Srisurapanont K., Phongkhun K., Sanguankeo A., Torvorapanit P., Moonla C., Plongla R., Kates O.S., Avery R.K., Nematollahi S., Permpalung N. Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis. Clinical Microbiology and Infection (2023). doi:10.1016/j.cmi.2023.04.021 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82890
Title
Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis
Other Contributor(s)
Abstract
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.