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Volume 26, Number 6—June 2020
Synopsis

Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome

Taylor Kain, Patrick J. Lindsay, Neill K.J. Adhikari, Yaseen M. Arabi, Maria D. Van Kerkhove, and Robert A. FowlerComments to Author 
Author affiliations: University of Toronto, Toronto, Ontario, Canada (T. Kain, P.J. Lindsay, N.K.J. Adhikari, R.A. Fowler); Harvard University, Boston, Massachusetts, USA (P.J. Lindsay); Sunnybrook Health Sciences Center, Toronto (N.K.J. Adhikari, R.A. Fowler); King Saud Bin Abdulaziz University for Health Center, Riyadh, Saudi Arabia (Y.M. Arabi); King Abdullah International Medical Research Center, Riyadh (Y.M. Arabi); World Health Organization, Geneva, Switzerland (M.D. Van Kerkhove)

Main Article

Table 2

Underlying conditions, age of study populations, overall mortality rates, and mortality rates by intervention (where applicable) for studies included in a systematic review of evidence for MERS treatment with pharmacologic and supportive therapies, by type of study*

Reference Age, y Underlying conditions
 Intervention
≥1 Diabetes mellitus CKD Mortality rate
Intervention Comparison Total
Nonrandomized, single-arm intervention study with historical comparisons
(12) 66 (median) NR 15 (47%) 16 (50%)
6 (19%) on dialysis IFN-β1a vs IFN-α2a 64% IFN-β1a 85% IFN-α2a 69%
(13) 46 (median ECMO); 50 (median no ECMO) NR 18 (51%) 5 (14%) ECMO 65% 100% 83%
(14)
 66 y (mean)
 NR
 30 (68%)
 11 (26%)
 RBV + IFN-α2a
 14d: 30%; 28d: 70%
 14d: 71%,28d: 83%
 52% at 14 d; 77% at 28 d
Prospective cohort study
(15) 49 (mean) 11 (47%) 4 (13%)
NS 1 (25%) 1 (3%)
NS 0 (0%) NA NA NA 20%
(16)
 57 (median)
 NR
 5 (63%)
 NR
 NA
 NA
 NA
 75%
Retrospective cohort study
(17) 58 (mean steroids); 55 (mean no steroids) 132 (87%) steroids
115 (73%) no steroids 87 (58%) steroids
69 (44%) no steroids 43 (29%) steroids
47 (30%) no steroids Steroids 90-d 74%
Hospital 78% 58% 90-d
Hospital 58% 66%
(18) 58 (median) 265 (80%)
NS 199 (75%) 162 (49%)
NS 124 (77%) 100 (30%)
NS 80 (80%) MERS vs non-MERS SARI 66% 31% NA
(19) 59 (median) NR 17 (55%)
NS 13 (77%) 6 (19%)
NS 4 (75%) NA NA NA 70%
(20) 45 (median) NR 9 (31%)
NS 7 (78%) 8 (28%)
NS 8 (100%) NA NA NA 35%
(21) 54 (median) 12 (86%) 6 (43%) 6 (42%)
3 (21%) on dialysis NA NA NA 64% 90 d,
43% 28 d
(22) 54 (median) 36 (71%) 17 (33%)
NS 8 (47%) 14 (28%) had ESRD
NS 8 (57%) NA NA NA 37%
(23) 48 (mean) NR NR NR NA NA NA 25%
(24) 56 (median macrolides); 58 (median no macrolides) 106 (78%) vs. 175 (82%) 72 (53%) vs. 98 (46%) 41 (30%) vs. 68 (32%) Macrolides 60% 70% 66%
(25) 60 (median NIV); 58 (median IMV) 88 (84%) vs. 164 (83%) 62 (59%) vs. 95 (48%) 31 (30%) vs. 68 (35%) NIV 69% 76% 73%
(26)
 58 (median RBV/IFN); 58 (no RBV/IFN)
 121 (84%) vs. 160 (78%)
 84 (58%) vs. 86 (42%)
 53 (37%) vs. 56 (27%)
 RBVIFN
 74%
 62%
 66%
Case series without evaluation of treatment
(27) 58 (mean) 5 (100%) 4 (80%) 5 (100%) NA NA NA 100%
(28) 59 (median) NR 8 (67%) 5 (42%) NA NA NA 58% at 90 d, 42% at 28 d
(29) 57 vs 52 (median) NR 52 (49%) 21 (20%) NA 39% 54% 51%
(30) 59 (mean) 3 (50%) 0 (0%) 0 (0%) NA NA NA 60%
(31) 58 (mean) NR NR NR NA NA NA 63% (0% in included patients)

*CKD, chronic kidney disease; ESRD, end-stage renal disease; HCW, health-care workers; IFN, interferon; IMV, invasive mechanical ventilation; MERS, Middle East respiratory syndrome; NIV, noninvasive ventilation; NR, not reported; NS, nonsurvivors; NA, not applicable; RBV, ribavirin; SARI, severe acute respiratory infection.

Main Article

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