Nipah encephalitis, a fatal encephalitis with bats as reservoir
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Ribavirin, a very broad-spectrum virustatic anti-viral agent, was tried on an empirical basis in the patients. In an open-label trial of 140 patients with 54 patients as controls, there were 45 deaths (32%) in the ribavirin group versus 29 deaths (54%) in the control arm, representing a reduction in mortality of 36%. This trial suggest that ribavirin may be useful in the treatment of acute Nipah encephalitis [35]. However, combined chloroquine and ribavirin treatment has been found not able to prevent death in a hamster model of Nipah and Hendra virus infection [36]. Another trial using poly(I)-poly(C12U) but not ribavirin prevents death in a hamster model of Nipah virus infection [37]. Neutralizing antibodies and various vaccines have also been found to protect against lethal disease in animal models of acute Nipah virus infection [38–42].
SARS-CoV Infections in Humans
Sunit K. Singh in Human Respiratory Viral Infections, 2014
Ribavirin is a nucleoside analog. This drug has broad-spectrum antiviral activity against many DNA and RNA viruses. This drug was naturally firstly and widely chosen as an empirical therapy for SARS. Ribavirin was commonly administered with steroid as empirical treatment for SARS. A lot of criticisms were raised for the use of this drug in SARS. Ribavirin has no direct in vitro activity against SARS-CoV. Clinical experience also did not support a substantial effect of this drug. Beneficial effects, if any, as suggested in an early anecdotal report, might be the immunomodulatory actions of ribavirin. Ribavirin, on the other hand, did have significant side effects. Adverse effects, such as hemolytic anemia, elevated transaminase levels, and bradycardia, are more common in regime with higher dosages. Lower doses of ribavirin appear to be more tolerable. Side effects were also more frequent in the elderly.119,120,122,138,139,195
Practice Paper 7: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Interferons are endogenous proteins secreted by the immune system that inhibit viral replication. IFN-α is known to have activity against the hepatitis C RNA virus, and is often used in the management of chronic hepatitis C. The majority of patients have a good initial response to IFN-α, but only 25% derive a sustained benefit. It has recently been shown that the combination of IFN-α and the antiviral drug ribavirin is more effective than IFN-α alone in the management of hepatitis C. Therefore, it is now recommended that these drugs be used in conjunction in moderate-to-severe hepatitis C infection.
The COVID-19 pandemic
Published in Critical Reviews in Clinical Laboratory Sciences, 2020
Marco Ciotti, Massimo Ciccozzi, Alessandro Terrinoni, Wen-Can Jiang, Cheng-Bin Wang, Sergio Bernardini
Patients should also be given antiviral therapy. Lopinavir/ritonavir is an approved antiviral drug that blocks the cleavage of Gag-Pol polyprotein. Lopinavir is used to treat human immunodeficiency virus-1 infection, and its application in COVID-19 infection is mainly based on the treatment of MERS-CoV. Ribavirin is a synthetic nucleoside antiviral agent with broad-spectrum antiviral activity that can inhibit DNA and RNA viruses [110]. For the new coronavirus pneumonia, the latest Chinese clinical guidance recommends the combined application of ribavirin and interferon or lopinavir/ritonavir. Redoxivir has shown significant effect in the treatment of SARS and MERS virus infections. Holshue et al. treated the first case of COVID-19 infection in the United States with remdesivir, and the clinical symptoms and signs improved significantly after that [30]. In addition, antiviral drugs such as darunavir, abidor and fapiravir can theoretically be used in the therapy of COVID-19 infection, but their specific efficacy still needs to be verified by animal and clinical experiments.
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 broad-spectrum antiviral recommendations for drug discovery against COVID-19
Published in Drug Metabolism Reviews, 2020
Abu Hazafa, Khalil ur-Rahman, Ikram-ul- Haq, Nazish Jahan, Muhammad Mumtaz, Muhammad Farman, Huma Naeem, Faheem Abbas, Muhammad Naeem, Sania Sadiqa, Saira Bano
During the in vitro study of ribavirin against SARS-CoV, it proved as an important antiviral therapeutic drug (Cinatl et al. 2003; Kumaki et al. 2017), and no virologic effects were reported during the application of ribavirin as monotherapy (Falzarano et al. 2013; Mo and Fisher 2016). Like on SARS-CoV, the ribavirin also has the broad-spectrum antiviral activity on MERS-CoV. The in vitro study revealed that high medications of ribavirin effectively induced 50% inhibitory concentration (IC50) that was recorded as 41.45 µg/mL(Kumar et al. 2017). Few clinical trials of ribavirin are also reported in the literature and found that a high level of an intravenous dose of ribavirin of about 1000 mg determined 24 µg/mL (IC50) (Falzarano et al. 2013). However, a study conducted by single-center RCT on SARS-CoV-infected persons reported that the ribavirin and interferon-1α have no noteworthy differences to discharge and symptom improvement (Zhao et al. 2003). Based on these significant broad-spectrum findings, the ribavirin could be a great therapeutic option to reduce the newly emerged novel coronavirus, namely COVID-19.
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