Ribavirin Aerosol in the Treatment of SARS-CoV-2: A Case Series

Abstract

Ribavirin is an inosine monophosphate dehydrogenase inhibitor with demonstrated activity against coronaviruses, including SARS-CoV-2. Five hospitalized patients with COVID-19 (confirmed by positive tests for SARS-CoV-2) received treatment with ribavirin for inhalation solution (ribavirin aerosol) as part of a compassionate use program. Patients included four men and one woman, with an age range of 29–72 years. Patients were managed according to international and Italian treatment guidelines for COVID-19. In addition, therapy with ribavirin aerosol 100 mg/mL was administered for 30 min twice daily for 6 days (i.e., 12 doses) in all patients. In order to address concerns about a possible increase in viral dispersal with the use of a nebulizer, healthcare providers remained outside the patient room during ribavirin aerosol administration. Pretreatment chest computed tomography (CT) scans showed pseudonodular areas of parenchymal thickening in the upper right lobe with associated ground glass opacities, multiple areas of parenchymal consolidation in both lower lobes with associated ground glass opacities, bilateral parenchymal thickening and multiple associated ground glass areas, or focal ground glass areas in the upper lobes bilaterally, which were almost completely resolved (three patients) or moderately cleared (one patient) on imaging at the end of ribavirin treatment. For a fifth patient, CT scans showed a stable pulmonary picture at the end of ribavirin treatment. No adverse reactions to ribavirin treatment were observed in any of the five patients. All patients recovered fully, and nasopharyngeal swabs obtained after hospital discharge tested negative for SARS-CoV-2. Ribavirin aerosol appears to be efficacious in the treatment of patients with COVID-19. A controlled trial of ribavirin aerosol is ongoing and will provide additional data across a broader patient population.

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“…One of the patient has been reported to be with obesity. Chest CT scans of all five patients showed to be present with multiple areas of parenchymal thickening and ground glass opacities [39].…”

“…COVID-19 has been associated with hyper inflammation [10][11][12][13][14][15][16][17][18] and delayed humoral immune respo--nses [19,20,21,22,23,24]. Most of the complications with COVID-19 patients have been associated with early hypoxia, ARDS, pneumonia [60,77, [35][36][37][38][39] and Acute Lung Injury [30][31][32][33][34]. Viral load has been found to be associated directly with incidence of lung injury/epithelial injury or remote organ injury in COVID-19 patients [25][26][27][28][29][30].…”

“…This immune dysregulation might have suppressed the advantages of Ribavirin in final outcome of severe patients. [39]. One of the patient has been reported to be with obesity.…”

“…Messina et.al (published on June 28, 2021) in their study of four (4) men and (1) one women with ages ranging from 29-72 years reported a successful clinical outcomes in administration of Aerosol Ribavirin for the treatment of SARS-COV-2 [39]. Their group administered the patients with 100mg/ml of Ribavirin aerosol for 30 min twice daily for 6 days.…”

“…Their group administered the patients with 100mg/ml of Ribavirin aerosol for 30 min twice daily for 6 days. (I.e: 12 doses) (For more information and data Please refer to original data from original author's publication -Messina et.al- [39]) [39].…”