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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 3

Narrative summary of treatments for MERS in humans, based on a systematic review of evidence for MERS treatment with pharmacologic and supportive therapies*

Reference Patients treated, no. Study type Specifics of intervention or analysis RoB Outcome† Certainty of evidence
Ribavirin
(22) 19 Retrospective cohort study Multivariate logistic regression Serious aOR 0.66, 95% CI 0.04–12.36, p = 0.78 Very low evidence; no benefit
(20)
 10
 Retrospective cohort study
 Unadjusted
 Critical
 3/10 (30%) vs. 7/19 (37%), p = 1.0
Interferons: IFN-α2a, IFN-α2b, INF-β1a
(12) 13 (IFN-α2a); 11 (IFN-β1a) Nonrandomized single-arm intervention IFN-α2a vs IFN-β1a; all co-treated with RBV; unadjusted Serious aOR (IFN-α) 0.16, 95% CI 0.02–1.38, p = 0.09; aOR (IFN-β) 0.28, 95% CI 0.03–2.33, p = 0.24 Very low evidence; no benefit of IFN-α2a or IFN-β1a
(22) 8 (IFN-α); 23 (IFN-β) Retrospective cohort Multivariate logistic regression Serious aOR 0.47, 95% CI 0.02–10.4, p = 0.63 (IFN-α); aOR 0.68, 95% CI 0.04–10.3, p = 0.78 (IFN-β)
(20)
 19
 Retrospective cohort
 Unadjusted
 Critical
 6/19 (32%) vs. 4/10 (40%), p = 0.70
Ribavirin and IFN
(26) 144 Retrospective cohort Cox-proportional hazards model
Marginal structural model Moderate aHR 1.52, 95% CI 1.13–2.06, p = 0.006; aOR 1.03, 95% CI 0.73–1.44, p = 0.87 Low evidence no benefit; very low evidence harm
(14)
 20
 Nonrandomized single-arm intervention
 Unadjusted
 Serious
 14d: 6/20 (30%) vs. 17/24 (71%), p = 0.04; 28d: 14/20 (70%) vs. 20/24 (83%), p = 0.05
Corticosteroids
(17) 151 Retrospective cohort Marginal structural model Moderate aOR (mortality rate) 0.75; 95% CI 0.52–1.07, p = 0.12; aHR (RNA clearance) 0.35; 95% CI 0.17–0.72, p = 0.005 Low evidence no benefit; very low evidence harm
(22) 5 Retrospective cohort Multivariate logistic regression Serious aOR 2.92, 95% CI 0.1–63.6, p = 0.5
(15) 1 Prospective cohort Unadjusted Critical 0/24 (0%) vs. 1/6 (17%), p = 0.2
(23)
 NI
 Retrospective cohort
 Multivariate logistic regression
Paper lacking data
 Critical
 aOR 3.84, 95% CI 1.95–7.57, p<0.0001
Macrolide therapy
(24)
 136
 Retrospective cohort
 Multivariate logistic regression
Cox-proportional hazards model
 Moderate
 aOR (mortality rate) 0.84, 95% CI 0.47–1.51, p = 0.56; aHR (RNA clearance) 0.88, 95% CI 0.47–1.64, p = 0.68
 Low evidence no benefit
Mycophenolate mofetil
(22)
 8
 Retrospective cohort
 Unadjusted
 Serious
 8/8 (100%) vs. 0/19 (0%), p = 0.02
 Very low evidence of benefit
IVIG
(18) 23 Retrospective cohort Unadjusted Moderate 7/113 (6%) vs. 16/217 (7%), p = 0.7 Very low evidence of harm
(15)
 3
 Prospective cohort
 Unadjusted
 Critical
 3/6 (50%) vs. 0/2 (0%), p = 0.005
Convalescent plasma
(16)
 2
 Retrospective cohort
 Unadjusted
 Critical
 1/24 (4%) vs. 1/6 (17%), p = 0.37
 Very low evidence no benefit
Extracorporeal membrane oxygenation
(13) 17 Nonrandomized single-arm intervention Unadjusted Moderate 11/17 (65%) vs. 18/18 (100%), p = 0.02 Low evidence of benefit
(15)
 2
 Retrospective cohort
 Unadjusted
 Critical
 1/24 (4%) vs. 1/6 (17%), p = 0.4
Noninvasive ventilation
(25) 105 Retrospective cohort Multivariate logistic regression Moderate aOR 0.61, 95% CI 0.23–1.6, p = 0.27 Low evidence no benefit

*Narrative description was decided through consensus among authors based on RoB, type of study, and numbers of patients treated. aHR, adjusted hazard ratio; aOR; adjusted odds ratio; IFN, interferon; IVIg, intravenous immunoglobulin; NI, no information; RoB, risk of bias.
†Percentages in parentheses indicate mortality rates.

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