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Recent Developments in Therapies and Strategies Against COVID-19
Published in Hanadi Talal Ahmedah, Muhammad Riaz, Sagheer Ahmed, Marius Alexandru Moga, The Covid-19 Pandemic, 2023
Misbah Hameed, M. Zia-Ul-Haq, Marius Moga
Ribavirin may expose the patients to severe side effects and may cause hematologic toxicity at high doses. As shown in SARS trials, a high dose of ribavirin causes hemolytic anemia in approximately 60% of patients. In MERS trials, it was observed that approximately 40% of patients on combination therapy of ribavirin with interferon required blood transfusions while 75% of the patients suffering from SARS presented elevated transaminase levels. Severe side effects like hematologic and liver toxicity were also observed when ribavirin was used in trials against SARS. It uses is contraindicated in pregnancy [19].
Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Ribavirin is an antiretroviral drug used to treat hepatitis C. For a number of years animal models that had produced a high frequency of birth defects were the only information regarding this drug during pregnancy. However, a Ribavirin Registry has provided data on 180 live births, but there were only 29 among whom the exposure occurred during the first trimester (Sinclair et al., 2017). There were no defects in the 29 first trimester exposed: Based on the patterns of birth defects reported, preliminary findings do not suggest a clear signal of human teratogenicity for ribavirin. However, the current sample size is insufficient for definitive conclusions, and ribavirin exposure should be avoided during pregnancy and during the 6 months prior to pregnancy, in accordance with prescribing information.(Sinclair et al., 2017)
Hepatitis C
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Rebecca Pierce-Williams, Neil Silverman, Raja Dhanekula, Jonathan M. Fenkel, Danielle Tholey
Historically, before DAAs where available, interferon (IFN) and ribavirin were used in non-pregnant adults for HCV treatment. IFN alpha has been used in pregnancy for the treatment of conditions such as essential thrombocythemia or chronic myelocytic leukemia, and is unlikely to cause congenital malformations or other adverse effects [70]. IFN was combined with ribavirin in order to obtain SVR. Ribavirin is contraindicated in pregnancy due to its potential teratogenic effects. IFN and ribavirin should not be used in pregnancy for treatment of HCV.
Diagnostic and management strategies for chronic hepatitis E infection
Published in Expert Review of Anti-infective Therapy, 2023
Florence Abravanel, Sébastien Lhomme, Olivier Marion, Jean Marie Péron, Nassim Kamar, Jacques Izopet
The therapeutic arsenal for treating chronic hepatitis is rather meager. Ribavirin or Peg-interferon alpha are the only drugs that have proven their efficacy in immunocompromised patients but both produce side effects. A large study evaluating ribavirin monotherapy found that 28% required dose reduction due to adverse hematologic effects [48]; other side effects may include mood disturbances, sleeping disorders, and neuropathy. A small number of patients relapse or do not respond to one or two courses of ribavirin therapy, and if interferon alpha is contra-indicated, no alternative drug is validated. A better understanding of the optimal dosage and duration of ribavirin is also required as it was demonstrated that ribavirin dose reduction was associated with ribavirin failure [48]. The mechanism by which ribavirin acts on HEV replication is still unclear and potential mutations in the virus genome that can influence the efficacy should be further studied by whole-genome sequencing.
The mechanism and pharmacodynamics of 2-((1H-indol-3-yl)thio/sulfinyl)-N-pheny acetamide derivative as a novel inhibitor against human respiratory syncytial virus
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2022
Ningning Cheng, Nan Jiang, Yuanhui Fu, Zhuxin Xu, Xianglei Peng, Jiemei Yu, Shan Cen, Yucheng Wang, Guoning Zhang, Yanpeng Zheng, Jinsheng He
Human respiratory syncytial virus (RSV) is an enveloped, negative-sense, single-stranded RNA virus and belongs to the Pneumovirus family and the Orthopneumovirus genus1–4. It is 15.2 kb in length and contains 10 genes encoding 11 proteins, NS1, NS2, N, P, M, SH, G, F, M2-1, M2-2, and L5–8. RSV is a leading cause of lower respiratory tract infection in nearly all children by 2-year-old globally and it was estimated that there were 3.2 million hospitalised cases and about 60,000 deaths annually9–12. RSV is also an important pathogen of severe lower respiratory tract disease in the elderly and adults with immunodeficiency disorders13,14. Unfortunately, there is no safe and effective vaccine licenced against RSV infection. Only ribavirin and palivizumab are the available drugs for the treatment of RSV infection15–18. Yet, being a broad-spectrum antiviral drug, ribavirin is not recommended due to its poor efficacy and side effects. Palivizumab, a costly humanised monoclonal antibody for RSV, can only be used to prevent RSV infection for the young and high-risk children born prematurely, with chronic lung disease or congenital heart disease19–21. Therefore, the development of safe and effective anti RSV drugs has important clinical significance22–24.
Direct antiviral agents (DAAs) and their use in pregnant women with hepatitis C (HCV)
Published in Expert Review of Anti-infective Therapy, 2022
Sandra Abdul Massih, Ahizechukwu C. Eke
Ribavirin has been associated with teratogenic and embryotoxic effects, therefore not currently recommended for use during pregnancy [93,94], but newer ribavirin-free DAA regimens may have promise for use during pregnancy. Until the recent SOF/LDV pharmacokinetic and safety study, there were no in-human studies demonstrating the safety and efficacy of DAAs in pregnant individuals. In pre-clinical animal studies of SOF/LDV, no serious acute or chronic toxicities were described [34]. Both LDV and SOF metabolites (GS-331007) were noted to be excreted in breast milk of animal models, with no adverse effects on neonatal and infant development [34,37]. In addition, a recent case-report of a mother who breastfed for 3 weeks while on SOF/LDV demonstrated no significant adverse events [73]. Safety data from the SOF/LDV pharmacokinetic and safety study continue to be reassuring.