tetano
Editor, Senior Moderator
Eur J Pharmacol
. 2021 Jun 11;174248.
doi: 10.1016/j.ejphar.2021.174248. Online ahead of print.
Interferon therapy in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis of clinical studies
Kiarash Saleki[SUP] 1 [/SUP], Shakila Yaribash[SUP] 2 [/SUP], Mohammad Banazadeh[SUP] 3 [/SUP], Ehsan Hajihosseinlou[SUP] 4 [/SUP], Mahdi Gouravani[SUP] 4 [/SUP], Amene Saghazadeh[SUP] 5 [/SUP], Nima Rezaei[SUP] 6 [/SUP]
Affiliations
Abstract
Concern regarding coronavirus (CoV) outbreaks has stayed relevant to global health in the last decades. Emerging COVID-19 infection, caused by the novel SARS-CoV2, is now a pandemic, bringing a substantial burden to human health. Interferon (IFN), combined with other antivirals and various treatments, has been used to treat and prevent MERS-CoV, SARS-CoV, and SARS-CoV2 infections. We aimed to assess the clinical efficacy of IFN-based treatments and combinational therapy with antivirals, corticosteroids, traditional medicine, and other treatments. Major healthcare databases and grey literature were investigated. A three-stage screening was utilized, and included studies were checked against the protocol eligibility criteria. Risk of bias assessment and data extraction were performed, followed by narrative data synthesis. Fifty-five distinct studies of SARS-CoV2, MERS-CoV, and SARS-CoV were spotted. Our narrative synthesis showed a possible benefit in the use of IFN. A good quality cohort showed lower CRP levels in Arbidol (ARB) + IFN group vs. IFN only group. Another study reported a significantly shorter chest X-ray (CXR) resolution in IFN-Alfacon-1 + corticosteroid group compared with the corticosteroid only group in SARS-CoV patients. In a COVID-19 trial, total adverse drug events (ADEs) were much lower in the Favipiravir (FPV) + IFN-α group compared with the LPV/RTV arm (P = 0.001). Also, nausea in patients receiving FPV + IFN-α regimen was significantly lower (P = 0.03). Quantitative analysis of mortality did not show a conclusive effect for IFN/RBV treatment in six moderately heterogeneous MERS-CoV studies (log OR=-0.05, 95% CI: (-0.71,0.62), I[SUP]2[/SUP] =44.71%). A meta-analysis of three COVID-19 studies did not show a conclusive nor meaningful relation between receiving IFN and COVID-19 severity (log OR=-0.44, 95% CI: (-1.13,0.25), I[SUP]2[/SUP] =31.42%). A lack of high-quality cohorts and controlled trials was observed. Evidence suggests the potential efficacy of several combination IFN therapies such as lower ADEs, quicker resolution of CXR, or a decrease in inflammatory cytokines; Still, these options must possibly be further explored before being recommended in public guidelines. For all major CoVs, our results may indicate a lack of a definitive effect of IFN treatment on mortality. We recommend such therapeutics be administered with extreme caution until further investigation uncovers high-quality evidence in favor of IFN or combination therapy with IFN.
Keywords: COVID-19; IFN; Interferon; MERS-CoV; Middle-East Respiratory Syndrome; SARS-CoV; SARS-CoV2; Severe Acute Respiratory Syndrome.
. 2021 Jun 11;174248.
doi: 10.1016/j.ejphar.2021.174248. Online ahead of print.
Interferon therapy in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis of clinical studies
Kiarash Saleki[SUP] 1 [/SUP], Shakila Yaribash[SUP] 2 [/SUP], Mohammad Banazadeh[SUP] 3 [/SUP], Ehsan Hajihosseinlou[SUP] 4 [/SUP], Mahdi Gouravani[SUP] 4 [/SUP], Amene Saghazadeh[SUP] 5 [/SUP], Nima Rezaei[SUP] 6 [/SUP]
Affiliations
- PMID: 34126092
- DOI: 10.1016/j.ejphar.2021.174248
Abstract
Concern regarding coronavirus (CoV) outbreaks has stayed relevant to global health in the last decades. Emerging COVID-19 infection, caused by the novel SARS-CoV2, is now a pandemic, bringing a substantial burden to human health. Interferon (IFN), combined with other antivirals and various treatments, has been used to treat and prevent MERS-CoV, SARS-CoV, and SARS-CoV2 infections. We aimed to assess the clinical efficacy of IFN-based treatments and combinational therapy with antivirals, corticosteroids, traditional medicine, and other treatments. Major healthcare databases and grey literature were investigated. A three-stage screening was utilized, and included studies were checked against the protocol eligibility criteria. Risk of bias assessment and data extraction were performed, followed by narrative data synthesis. Fifty-five distinct studies of SARS-CoV2, MERS-CoV, and SARS-CoV were spotted. Our narrative synthesis showed a possible benefit in the use of IFN. A good quality cohort showed lower CRP levels in Arbidol (ARB) + IFN group vs. IFN only group. Another study reported a significantly shorter chest X-ray (CXR) resolution in IFN-Alfacon-1 + corticosteroid group compared with the corticosteroid only group in SARS-CoV patients. In a COVID-19 trial, total adverse drug events (ADEs) were much lower in the Favipiravir (FPV) + IFN-α group compared with the LPV/RTV arm (P = 0.001). Also, nausea in patients receiving FPV + IFN-α regimen was significantly lower (P = 0.03). Quantitative analysis of mortality did not show a conclusive effect for IFN/RBV treatment in six moderately heterogeneous MERS-CoV studies (log OR=-0.05, 95% CI: (-0.71,0.62), I[SUP]2[/SUP] =44.71%). A meta-analysis of three COVID-19 studies did not show a conclusive nor meaningful relation between receiving IFN and COVID-19 severity (log OR=-0.44, 95% CI: (-1.13,0.25), I[SUP]2[/SUP] =31.42%). A lack of high-quality cohorts and controlled trials was observed. Evidence suggests the potential efficacy of several combination IFN therapies such as lower ADEs, quicker resolution of CXR, or a decrease in inflammatory cytokines; Still, these options must possibly be further explored before being recommended in public guidelines. For all major CoVs, our results may indicate a lack of a definitive effect of IFN treatment on mortality. We recommend such therapeutics be administered with extreme caution until further investigation uncovers high-quality evidence in favor of IFN or combination therapy with IFN.
Keywords: COVID-19; IFN; Interferon; MERS-CoV; Middle-East Respiratory Syndrome; SARS-CoV; SARS-CoV2; Severe Acute Respiratory Syndrome.