Table 3.
Agents applied for treatment of humans with severe acute respiratory syndrome coronavirus infection in 2003
| Agents | |
|---|---|
| Ribavirin | Ribavirin given at 1.2 g three times a day orally for 2 wk resulted in a drop in hemoglobin of >2 g/dL from baseline in 59% of patients, with evidence of hemolysis documented in 36%.83 Based on a higher dosage of ribavirin for treating hemorrhagic fever virus, patients with SARS-CoV infection in Toronto developed more toxicity, including elevated transaminases and bradycardia.61 |
| Protease inhibitor | Two retrospective, matched cohort studies have compared the clinical outcome of patients who received protease inhibitors (lopinavir 400 mg/ritonavir 100 mg) in addition to ribavirin, either as initial therapy within 5 d of onset of symptoms or as rescue therapy after pulsed methylprednisolone treatment for worsening respiratory symptoms; these were compared with historical controls who received ribavirin alone as initial antiviral therapy.84, 85 The addition of lopinavir/ritonavir as initial therapy was associated with reduced overall death rate (2.3%) and intubation rate (0%), in comparison with a matched cohort that received standard treatment (15.6% and 11%, respectively)85; there was also evidence of reduction in viral loads. Other beneficial effects included a reduction in methylprednisolone use and less nosocomial infections.84 However, the subgroup that had received lopinavir/ritonavir as rescue therapy fared no better than the matched cohort, and received a higher mean dose of methylprednisolone.86 The improved clinical outcome in patients who received lopinavir/ritonavir as part of the initial therapy is supported by the observations that both peak (9.6 μg/mL) and trough (5.5 μg/mL) serum concentrations of lopinavir could inhibit the virus. |
| Interferon | In an uncontrolled study in Toronto, interferon-alfacon-1 given within 5 d of illness resulted in improved oxygen saturation, more rapid resolution of radiographic lung opacities, and lower rates of intubation (11.1% vs 23.1%) and death (0.0% vs 7.7%); however, the sample size was small (n = 9 vs 13) and confounded by the concomitant use of systemic corticosteroid.86 |