Oral and Inhaled Ribavirin Treatment for Respiratory Syncytial Virus Infection in Lung Transplant Recipients.
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 treated RSV infected LTRs with limited data. METHODS: A retrospective study including all LTRs at Duke Hospital during January 2013-May 2017 with positive RSV PCR 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 one-year mortality was significantly higher in the inhaled RBV group [24.1% vs 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 FEV1 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 supports the use of oral RBV as a safe alternative to inhaled ribavirin in LTRs. Oxygen requirement > 2 L/min at diagnosis and FEV1 decline ≥ 5% post infection may be markers for increased mortality.
Permpalung, N; Thaniyavarn, T; Saullo, JL; Arif, S; Miller, RA; Reynolds, JM; Alexander, BD
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