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