Ribavirin for Crimean-Congo hemorrhagic fever: systematic review and meta-analysis

Soares-Weiser, Karla, Thomas, Sherine, Thomson, Gail and Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 (2010) 'Ribavirin for Crimean-Congo hemorrhagic fever: systematic review and meta-analysis'. BMC Infectious Diseases, Vol 10, Issue 207.

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Abstract

Background
Crimean-Congo Hemorrhagic Fever epidemics often occur in areas where health services are limited, and are associated with case fatality rates of 5-40%. Besides intensive care, ribavirin is often recommended. A solid evidence base for the use of this drug will help justify assuring access to the drug in areas where epidemics are common.

Methods
We carried out a systematic review of observational and experimental studies of people with suspected or confirmed Crimean-Congo Haemorrhagic Fever that included comparisons between patients given ribavirin and those not. We extracted data on mortality, hospital stay, and adverse events. Risk of bias was assessed using a standard checklist, and data were presented in meta-analytical graphs, stratified by study design, and summary estimates were assessed using the GRADE method.

Results
Twenty-one unique studies, including one randomised controlled trial of ribavirin, were included. Quality of the evidence was very low, with a Down and Black median score of 4 (maximum possible 33). Ribavirin treatment was not shown to be superior to no ribavirin treatment for mortality rate in a single RCT (RR: 1.13, 95%CI: 0.29 to 4.32, 136 participants, GRADE= low quality evidence); but ribavirin was associated with reduced mortality by 44% when compared to no ribavirin treatment in the pooled observational studies (RR: 0.56, 95%CI: 0.35 to 0.90, 955 participants; GRADE=very low quality evidence). Adverse events were more common with the ribavirin patients, but no severe adverse events were reported. No difference in length of hospital stay was reported.

Conclusions
No clear message of benefit is available from the current data on ribavirin as observational data are heavily confounded, and the one trial carried out has limited power. However, ribavirin could potentially have large benefits in this condition and these results very clearly indicate a pragmatic, randomised controlled trial in the context of good quality supportive care is urgently needed and ethically justified.

Item Type:	Article
Additional Information:	Originally published as: Soares-Weiser, K. et al. "Ribavirin for Crimean-Congo hemorrhagic fever: systematic review and meta-analysis". BMC Infectious Diseases 2010, 10:207 doi:10.1186/1471-2334-10-207
Subjects:	WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 534 Viral hemorrhagic fevers WA Public Health > WA 105 Epidemiology QV Pharmacology > QV 4 General works
Faculty: Department:	Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):	https://doi.org/10.1186/1471-2334-10-207
Depositing User:	Faye Moody
Date Deposited:	23 Jul 2010 10:03
Last Modified:	06 Sep 2019 10:14
URI:	https://archive.lstmed.ac.uk/id/eprint/1077

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