Impact of aerosolized ribavirin on mortality in 280 allogeneic haematopoietic stem cell transplant recipients with respiratory syncytial virus infections

Abstract

Our results demonstrate that RSV infections are a significant cause of morbidity and mortality in high-risk allo-HSCT recipients and ribavirin-based antiviral therapy at the URTI stage had a positive impact on both outcomes in this vulnerable population with multiple risk factors.

Compassionate use experience with high‐titer respiratory syncytical virus (RSV) immunoglobulin in RSV‐infected immunocompromised persons

“…However, several retrospective studies and a recent pooled analysis suggest that ribavirin in any form is associated with decreased progression of upper respiratory tract infection (URTI) to LRTI (45% down to 16%) and decreased mortality (70% down to 13%). 8,9 Although observational data suggest benefit of early treatment with ribavirin, multiple issues remain, including high cost ($29 953/day) toxicity, and administration difficulties with the inhaled preparation and of IV ribavirin. have not demonstrated clinical advantage, it is possible that immunodeficient patients might derive benefit.…”

“…[5][6][7][8][9] Optimal therapy for immunocompromised patients with RSV infection has not been defined and data on treatment are limited. Inhaled ribavirin (Virazole ® ) is US Food and Drug Administration (FDA) approved only for use in RSV-infected hospitalized infants and young children.…”

Characterization of Ribavirin Aerosol With Small Particle Aerosol Generator and Vibrating Mesh Micropump Aerosol Technologies

“…[4][5][6][7] High-dose, short-duration aerosolized ribavirin therapy (60 mg/mL), administered for 2 h 3 times/d has been shown to be well-tolerated by patients while achieving the same ribavirin blood and secretion levels as the previously recommended 20 h of continuous therapy. 8 The shorter intermittent-duration administration of aerosol has become the standard inhalation schedule because it has been proven to be equally effective as the continuous delivery while reducing environmental contamination.…”

“…At present, ribavirin is primarily used to treat immunocompromised patients who develop respiratory syncytial virus and has been shown to be effective at halting the progression of infection from the upper to the lower respiratory tract and at reducing the associated morbidity and mortality. 4 Aerosol delivery has been minimized when possible due to the cumbersomeness of the small-particle aerosol generator-2 system and the need to use containment canopies or controlled air handling to protect caregivers from potential exposure. 19 Although oral and intravenous preparations have been effective, they do not act directly on the respiratory mucosa and are associated with adverse effects, such as neutropenia.…”

A New Era for Ribavirin Aerosols to Treat Respiratory Syncitial Virus Infections in Immunocompromised Patients?

“…During the last few years, this treatment has been revisited. New clinical data support the efficiency of aerosolized ribavirin to treat respiratory syncitial virus infections in immunocompromised hematopoietic cell transplant recipients [3][4][5] and in patients with cancer. 6 In 2012, Chemaly et al 6 introduced the possibility of administering aerosolized ribavirin, still with the smallparticle aerosol generator-2 but intermittently, in the form of 2 g over 3 h every 8 h daily, rather than continuously (ie, 6 g over 18 h daily).…”