Ribavirin treatment for respiratory syncytial virus infection in patients with haematologic malignancy and haematopoietic stem cell transplant recipients: a systematic review and meta-analysis

Published:1 October 2023 DOI: 10.1016/j.cmi.2023.04.021 PMID: 37116860

Kasama Manothummetha , Thanuthong Mongkolkaew , Punyot Tovichayathamrong , Rabhas Boonyawairote , Tanaporn Meejun , Karan Srisurapanont , Kasidis Phongkhun , Anawin Sanguankeo , Pattama Torvorapanit , Chatphatai Moonla , Rongpong Plongla , Olivia S. Kates , Robin K. Avery , Saman Nematollahi , Nitipong Permpalung

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.