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The use of Ribavirin for Respiratory syncytial virus

Sep 18，2024

RSV

Respiratory syncytial virus (RSV) is a single-stranded, negative-sense, enveloped RNA virus commonly infects children worldwide. RSV-associated diseases have caused an estimated 1.8 million hospital admissions and 40,000 deaths among children. RSV can cause lower respiratory tract infections (LRTIs) in all age groups, adults with comorbidities, and immunocompromised patients[1]. It has now been recognized as a problem in the adult population, with significant mortality and morbidity in immunocompromised hosts. The clinical manifestations of RSV infection in an immunocompromised individual depend on the degree of immunosuppression.

Ribavirin

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Ribavirin, a guanosine analogue, has been widely used in many institutions to treat RSV, and current guidelines recommend Ribavirin for RSV treatment in immunocompromised patients, including patients with HM or HSCT and lung transplant recipients. Given the lack of data from randomized controlled trials (RCTs), using Ribavirin for RSV treatment has been controversial[2].

Ribavirin is a synthetic guanosine analogue with broad-spectrum antiviral activity. Ribavirin was approved for treating infections with the respiratory syncytial virus in infants and chronic hepatitis C infections in combination with pegylated IFN-α and/or direct-acting antivirals[3]. Ribavirin has also been used off-label to treat other viral infections such as Lassa virus infection. Ribavirin was shown to exert in vitro antiviral activity against CHIKV (EC50 of 341 μM) and resulted in a synergistic inhibitory effect when combined with IFN-α2b. The combination of Ribavirin and doxycycline also produced a good antiviral effect against CHIKV replication in Vero cells and reduced the viral load and inflammation in infected ICR mice.

References

[1] Sofia Tejada. “Ribavirin for Treatment of Subjects with Respiratory Syncytial Virus-Related Infection: A Systematic Review and Meta-Analysis.” Advances in Therapy 39 9 (2022): 4037–4051.

[2] Wasey Ali Yadullahi Mir. “Successful Treatment of Respiratory Syncytial Virus Infection in an Immunocompromised Patient With Ribavirin.” Cureus (2021): e16930.

[3] Kasama Manothummetha . “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 29 10 (2023): Pages 1272-1279.

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