IFN-α2a or IFN-β1a in combination with ribavirin to treat Middle East respiratory syndrome coronavirus pneumonia: a retrospective study

• Published in: Journal of Antimicrobial Chemotherapy Vol. 70; no. 7; pp. 2129 - 2132
• Main Authors: Shalhoub, Sarah, Farahat, Fayssal, Al-Jiffri, Abdullah, Simhairi, Raed, Shamma, Omar, Siddiqi, Nauman, Mushtaq, Adnan
• Format: Journal Article Web Resource
• Language: English
• Published: England Oxford University Press 01.07.2015
• Subjects: Adult; Aged; Aged, 80 and over; Antiviral Agents - administration & dosage; Coronavirus Infections - drug therapy; Drug Therapy, Combination - methods; Female; Humans; Interferon-alpha - administration & dosage; Interferon-beta - administration & dosage; Lung - virology; Male; Middle Aged; Middle East Respiratory Syndrome Coronavirus - isolation & purification; Original Research; Plasma - virology; Pneumonia, Viral - drug therapy; Real-Time Polymerase Chain Reaction; Retrospective Studies; Ribavirin - administration & dosage; Treatment Outcome; Viral Load; interferon; treatment; MERS-CoV
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkv085

Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant mortality. We examined the utility of plasma MERS-CoV PCR as a prognostic indicator and compared the efficacies of IFN-α2a and IFN-β1a when combined with ribavirin in reducing MERS-CoV-related mortality rates. We retrospectively analysed 32 patients with confirmed MERS-CoV infection, admitted between April 2014 and June 2014, by positive respiratory sample RT-PCR. Plasma MERS-CoV RT-PCR was performed at the time of diagnosis for 19 patients. The overall mortality rate was 69% (22/32). Ninety percent (9/10) of patients with positive plasma MERS-CoV PCR died compared with 44% (4/9) of those with negative plasma MERS-CoV PCR. Mortality rate in patients who received IFN-α2a was 85% (11/13) compared with 64% (7/11) in those who received IFN-β1a (P = 0.24). The mortality rate in patients with renal failure (14), including 8 on haemodialysis, was 100%. Age >50 years and diabetes mellitus were found to be significantly associated with mortality (OR = 26.1; 95% CI 3.58-190.76; P = 0.001 and OR = 15.74; 95% CI 2.46-100.67; P = 0.004, respectively). The median duration of viral shedding in patients who recovered was 11 days (range 6-38 days). Absence of fever was noted in 5/32 patients. Plasma MERS-CoV RT-PCR may serve as an effective tool to predict MERS-CoV-associated mortality. Older age and comorbid conditions may have contributed to the lack of efficacy of IFN-α2a or IFN-β1a with ribavirin in treating MERS-CoV. Absence of fever should not exclude MERS-CoV.