Oral and Inhaled Ribavirin Treatment for Respiratory Syncytial Virus Infection in Lung Transplant Recipients.

Published

Journal Article

BACKGROUND: Respiratory syncytial virus (RSV) infection in lung transplant recipients (LTRs) causes mortality rates of 10%-20% despite antiviral therapy. Ribavirin (RBV) has been used to treat RSV-infected LTRs with limited data. METHODS: A retrospective study including all LTRs at Duke Hospital during January 2013-May 2017 with positive RSV polymerase chain reaction respiratory specimens was performed. RESULTS: Fifty-six of 70 patients in the oral RBV group and 29 of 32 in the inhaled RBV group had symptomatic RSV infection. One patient receiving oral RBV had to prematurely stop drug due to significant nausea and vomiting. While unadjusted all-cause 1-year mortality was significantly higher in the inhaled RBV group (24.1% versus 7.1% [oral RBV], P = 0.03), adjusted hazard ratio (HR) for death and oral RBV use (compared to inhaled RBV), accounting for oxygen requirement and need for mechanical ventilation, showed the HR for death and oral RBV use was 0.38 ([0.10, 1.46], P = 0.38). The HR for death in patients with supplemental oxygen >2 L/min at diagnosis was 6.18 ([1.33, 26.83], P = 0.02). Kaplan-Meier curves showed patients with forced expiratory volume in 1 second decline ≥5% and ≥10% at 90 days post-RSV infection had a higher 1-year mortality (P = 0.004 and P = 0.001, respectively). CONCLUSIONS: Oral and inhaled RBV appear to be well tolerated in LTRs, and our data support the use of oral RBV as a safe alternative to inhaled ribavirin in LTRs. Oxygen requirement >2 L/min at diagnosis and forced expiratory volume in 1 second decline ≥5% postinfection may be markers for increased mortality.

Full Text

Duke Authors

Cited Authors

  • Permpalung, N; Thaniyavarn, T; Saullo, JL; Arif, S; Miller, RA; Reynolds, JM; Alexander, BD

Published Date

  • June 2020

Published In

Volume / Issue

  • 104 / 6

Start / End Page

  • 1280 - 1286

PubMed ID

  • 31568275

Pubmed Central ID

  • 31568275

Electronic International Standard Serial Number (EISSN)

  • 1534-6080

Digital Object Identifier (DOI)

  • 10.1097/TP.0000000000002985

Language

  • eng

Conference Location

  • United States