Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis
Objectives: Lassa fever (LF) causes annual outbreaks in endemic regions with high mortality of symptomatic patients. Ribavirin is recommended as standard treatment for LF in national and international guidelines but the evidence base for this recommendation has been questioned recently. Methods: We...
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doaj-5c5eaa658c094c6fad8a9da3ca3ead392020-11-25T02:49:58ZengElsevierInternational Journal of Infectious Diseases1201-97122019-10-01871520Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysisKirsten Alexandra Eberhardt0Johannes Mischlinger1Sabine Jordan2Mirjam Groger3Stephan Günther4Michael Ramharter5Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, GermanyDepartment of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Corresponding author.Objectives: Lassa fever (LF) causes annual outbreaks in endemic regions with high mortality of symptomatic patients. Ribavirin is recommended as standard treatment for LF in national and international guidelines but the evidence base for this recommendation has been questioned recently. Methods: We conducted a systematic review and included 6 studies providing efficacy data of ribavirin treatment for LF (PROSPERO protocol CRD42018103994). Results: Besides retrospective case series, the evidence mostly relies on a single prospective clinical trial with critical risk of bias. In this trial, LF associated mortality is reduced for patients with elevated aspartate aminotransferase (AST) when treated with ribavirin (OR 0.41, 95% CI 0.23–0.73), while mortality is higher for patients without elevated AST (OR 2.37, 95% CI 1.07–5.25). Conclusions: Based on the available data, current treatment guidelines may therefore put patients with mild LF at increased risk of death. The role of ribavirin in the treatment of LF requires urgent reassessment. Keywords: Lassa fever, Ribavirin, Haemorrhagic fever, LASVhttp://www.sciencedirect.com/science/article/pii/S1201971219303005 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kirsten Alexandra Eberhardt Johannes Mischlinger Sabine Jordan Mirjam Groger Stephan Günther Michael Ramharter |
spellingShingle |
Kirsten Alexandra Eberhardt Johannes Mischlinger Sabine Jordan Mirjam Groger Stephan Günther Michael Ramharter Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis International Journal of Infectious Diseases |
author_facet |
Kirsten Alexandra Eberhardt Johannes Mischlinger Sabine Jordan Mirjam Groger Stephan Günther Michael Ramharter |
author_sort |
Kirsten Alexandra Eberhardt |
title |
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis |
title_short |
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis |
title_full |
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis |
title_fullStr |
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis |
title_full_unstemmed |
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis |
title_sort |
ribavirin for the treatment of lassa fever: a systematic review and meta-analysis |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 |
publishDate |
2019-10-01 |
description |
Objectives: Lassa fever (LF) causes annual outbreaks in endemic regions with high mortality of symptomatic patients. Ribavirin is recommended as standard treatment for LF in national and international guidelines but the evidence base for this recommendation has been questioned recently. Methods: We conducted a systematic review and included 6 studies providing efficacy data of ribavirin treatment for LF (PROSPERO protocol CRD42018103994). Results: Besides retrospective case series, the evidence mostly relies on a single prospective clinical trial with critical risk of bias. In this trial, LF associated mortality is reduced for patients with elevated aspartate aminotransferase (AST) when treated with ribavirin (OR 0.41, 95% CI 0.23–0.73), while mortality is higher for patients without elevated AST (OR 2.37, 95% CI 1.07–5.25). Conclusions: Based on the available data, current treatment guidelines may therefore put patients with mild LF at increased risk of death. The role of ribavirin in the treatment of LF requires urgent reassessment. Keywords: Lassa fever, Ribavirin, Haemorrhagic fever, LASV |
url |
http://www.sciencedirect.com/science/article/pii/S1201971219303005 |
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