Tuesday, January 5, 2016

Treatment for MERS-CoV

  • Coronaviruses are RNA viruses which usually cause mild upper respiratory illnesses.
  • The emergence of SARS (severe acute respiratory Syndrome) MERS (Middle east respiratory syndrome) has focussed global attention on the clinical significance of coronaviruses
Vaccination:
  • no vaccine to prevent MERS-CoV infection
Treatment Option
  • there are still no proven or licensed therapies for any coronavirus infection
  • For severe cases, current treatment includes care to support vital organ functions
Ribavarin
  • The most commonly used agent was the broad spectrum antiviral ribavirin
  • mortality benefit was inconsistent with mortality rates of between 5% and 42.8%, two studies showed improvements of symptoms in 71.4%-80% of patients, and ICU admission rates of 13%-20%.
  • The major problem with ribavirin was the significant incidence of adverse events especially hemolysis which was reported in 68.5%
  • One study compared oseltamivir versus ribavirin and showed no obvious response to ribavirin, however, the treatment were started after 10-14 days of symptoms which might have led to the poorer outcomes
  • benefits when ribavirin was started within 48 hours of hospitalization or after diagnosis of SARS was established
Interferon-1α
  • showed no advantage of ribavirin over interferon in patients with SARS
  • led to improvements in clinical and laboratory parameters compared with control patients
Lopinavir/ritonavir
  • addition of lopinavir/ritonavir to ribavirin regimen was associated with improved clinical outcome and reduces the death rate comparing to ribavirin regimen alone in observational studies
  • There are reports that lopinavir/ritonavir is not active in vitro against the MERS-CoV
Convalescent plasma
  • mainly case reports which limit the generalizability of their findings.
  • In three studies of SARS patients, patients in the plasma group had a shorter hospital stay (58.3% -73.4% versus 15.6%- 19%; P < 0.001) and lower mortality than the comparator group (0%- 12.5% versus 17% 23.8%)
  • Cross- reactive antibodies may be present in convalescent plasma from SARS patients against other beta-coronavirus and may be associated with a better outcome, reduced mortality, and shorter hospital stay

References:
  1. http://www.sciencedirect.com/science/article/pii/S1201971213002294
  2. http://www.cdc.gov/coronavirus/mers/about/prevention.html
  3. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20797
  4. Guideline On Middle East Respiratory Syndrome coronavirus (MERS-CoV).2013

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