Table 1 Therapeutic interventions used in patients with SARS and MERS
From: Coronaviruses — drug discovery and therapeutic options
Type of intervention | Therapeutic intervention | Treatment effects | Refs |
|---|---|---|---|
Treatments used for SARS patients | |||
Antivirals | Ribavirin | No significant effect on clinical outcome | |
Ribavirin, lopinavir–ritonavir + corticosteroids | Patients who received ribavirin, lopinavir–ritonavir and a corticosteroid had lower 21-day ARDS and death rates than those who received ribavirin and a corticosteroid | ||
Interferon combination | Interferon alfa-1 + corticosteroid | Associated with improved oxygen saturation and more rapid resolution of radiographic lung opacities than systemic corticosteroid alone (uncontrolled study) | |
Corticosteroids | Pulsed methylprednisolone | Associated with an increased 30-day mortality rate (adjusted OR = 26.0, 95% CI = 4.4–154.8). Disseminated fungal infection and avascular osteonecrosis occurred following prolonged systemic corticosteroid therapy | |
A randomized, placebo-controlled study showed that plasma SARS-CoV RNA levels in weeks 2–3 of the illness were higher in patients given hydrocortisone (n = 10) than those given normal saline (n = 7) in the early phase of the illness, suggesting that early use of pulsed methylprednisolone might prolong viraemia | |||
Convalescent-phase plasma | Convalescent-phase plasma therapy | Has been used for severe respiratory tract infections including SARS and influenza. A systematic review and exploratory meta-analysis of patients with SARS or influenza treated with convalescent-phase plasma showed a reduction in mortality, but the treatment success was determined by its availability and timely administration | |
Among 80 non-randomized SARS patients who were given convalescent-phase plasma, the discharge rate at day 22 was 58.3% for patients (n = 48) treated within 14 days of illness onset versus 15.6% for those (n = 32) treated beyond 14 days | |||
Treatments used for MERS patients | |||
Combination of antivirals and interferons | Ribavirin + interferon alfa-2a or interferon alfa-2b | No significant effect on clinical outcome; case–control study showed significantly improved survival (14 out of 20 and 7 out of 24 in the treated and control groups, respectively; P = 0.004) at 14 days, but not at 28 days | |
Ribavirin + interferon beta-1a | Retrospective analyses showed no significant effect on clinical outcome | ||
Ribavirin, lopinavir–ritonavir + interferon alfa-2a | Viraemia resolved 2 days after commencement of treatment in a patient with severe MERS | ||
Corticosteroids | Pulsed methylprednisolone | Patients with severe MERS who were treated with systemic corticosteroid with or without antivirals and interferons had no favourable response | |
