Giuseppe
Emeritus
[Source: Antimicrobial Agents and Chemotherapy, full text: (LINK). Abstract, edited.]
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Efficacy of oral ribavirin in hematologic disease patients with paramyxovirus infection: analytic strategy using propensity scores
So-Youn Park a, Seunghee Baek b, Sang-Oh Lee a, Sang-Ho Choi a, Yang Soo Kim a, Jun Hee Woo a, Heungsup Sung c, Mi-Na Kim c, Dae-Young Kim d, Jung-Hee Lee d, Je-Hwan Lee d, Kyoo-Hyung Lee d and Sung-Han Kim a
Author Affiliations: <SUP>a</SUP>Departments of Infectious Diseases; <SUP>b</SUP>Departments of Clinical Epidemiology and Biostatistics; <SUP>c</SUP>Departments of Laboratory Medicine; <SUP>d</SUP>Departments of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
ABSTRACT
Few antiviral agents are available for treating paramyxovirus infections such as those involving respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (hMPV). We evaluated the effect of oral ribavirin on clinical outcomes of paramyxovirus infections in patients with hematological diseases. All adult patients with paramyxovirus were retrospectively reviewed over a 2-year period. Patients who received oral ribavirin were compared to those who received supportive care without ribavirin therapy. A propensity-matched case-control study and a logistic regression model with inverse probability of treatment weighting (IPTW) were performed to reduce the effect of selection bias in assignment for oral ribavirin therapy. A total of 145 patients including 64 (44%) with PIV, 60 (41%) with RSV, and 21 (15%) with hMPV, were analyzed. Of these 145 patients, 114 (78%) received oral ribavirin and the remaining 31 (21%) constituted the non-ribavirin group. 30-day mortality and underlying respiratory death were 31% (35/114) and 12% (14/114), respectively, for the oral ribavirin group vs. 19% (6/31) and 16% (5/31), respectively, for the non-ribavirin group (P = 0.21 and P = 0.56). In the case-control study, the 30-day mortality in the ribavirin group was 24% (5/21) vs. 19% (4/21) in the non-ribavirin group (P = 0.71). In addition, the logistic regression model with IPTW revealed no significant difference in 30-day mortality (adjusted hazard ratio of 1.3; 95% confidence interval [lsqb]95% CI[rsqb] of 0.3 to 5.8) between the two groups. Steroid use (adjusted odds ratio 5.67; P = 0.01) and upper respiratory tract infection (adjusted odds ratio 0.07; P = 0.001) was independently associated with mortality. Our data suggest that oral ribavirin therapy may not improve clinical outcomes in hematologic disease patients infected with paramyxovirus.
FOOTNOTES
Correspondence: Sung-Han Kim, MD, Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, Republic of Korea; Tel: +82-2-3010-3305; Fax: +82-2-3010-6970; E-mail: kimsunghanmd@hotmail.com
Copyright ? 2012, American Society for Microbiology. All Rights Reserved.
-Author Affiliations: <SUP>a</SUP>Departments of Infectious Diseases; <SUP>b</SUP>Departments of Clinical Epidemiology and Biostatistics; <SUP>c</SUP>Departments of Laboratory Medicine; <SUP>d</SUP>Departments of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
ABSTRACT
Few antiviral agents are available for treating paramyxovirus infections such as those involving respiratory syncytial virus (RSV), parainfluenza virus (PIV), and human metapneumovirus (hMPV). We evaluated the effect of oral ribavirin on clinical outcomes of paramyxovirus infections in patients with hematological diseases. All adult patients with paramyxovirus were retrospectively reviewed over a 2-year period. Patients who received oral ribavirin were compared to those who received supportive care without ribavirin therapy. A propensity-matched case-control study and a logistic regression model with inverse probability of treatment weighting (IPTW) were performed to reduce the effect of selection bias in assignment for oral ribavirin therapy. A total of 145 patients including 64 (44%) with PIV, 60 (41%) with RSV, and 21 (15%) with hMPV, were analyzed. Of these 145 patients, 114 (78%) received oral ribavirin and the remaining 31 (21%) constituted the non-ribavirin group. 30-day mortality and underlying respiratory death were 31% (35/114) and 12% (14/114), respectively, for the oral ribavirin group vs. 19% (6/31) and 16% (5/31), respectively, for the non-ribavirin group (P = 0.21 and P = 0.56). In the case-control study, the 30-day mortality in the ribavirin group was 24% (5/21) vs. 19% (4/21) in the non-ribavirin group (P = 0.71). In addition, the logistic regression model with IPTW revealed no significant difference in 30-day mortality (adjusted hazard ratio of 1.3; 95% confidence interval [lsqb]95% CI[rsqb] of 0.3 to 5.8) between the two groups. Steroid use (adjusted odds ratio 5.67; P = 0.01) and upper respiratory tract infection (adjusted odds ratio 0.07; P = 0.001) was independently associated with mortality. Our data suggest that oral ribavirin therapy may not improve clinical outcomes in hematologic disease patients infected with paramyxovirus.
FOOTNOTES
Correspondence: Sung-Han Kim, MD, Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul, Republic of Korea; Tel: +82-2-3010-3305; Fax: +82-2-3010-6970; E-mail: kimsunghanmd@hotmail.com
Copyright ? 2012, American Society for Microbiology. All Rights Reserved.
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