Efficacy of Oral Ribavirin in Lung Transplant Patients With Respiratory Syncytial Virus Lower Respiratory Tract Infection

• Type of Material: Article
• Authors: Andres Pelaez, Emory University; G Marshall Lyon III, Emory University; Seth Force, Emory University; Allan M. Ramirez, Emory University; David Neujahr, Emory University; Marianne Foster, Emory University; Priyumvada M. Naik, Emory University; Anthony A Gal, Emory University; Patrick O. Mitchell, Emory University; E. Lawrence, Emory University
• Language: English
• Date: 2009-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2019 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.healun.2008.10.008
• Title of Journal or Parent Work: Journal of Heart and Lung Transplantation
• ISSN: 1053-2498
• Volume: 28
• Issue: 1
• Start Page: 67
• End Page: 71
• Grant/Funding Information: Supported by the McKelvey Center for Lung Transplantation and Pulmonary Vascular Diseases, Emory University.
• Keywords: Surgery; RECIPIENTS; THERAPY; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Science & Technology; Life Sciences & Biomedicine; Transplantation; Respiratory System
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Background: Respiratory syncytial virus (RSV) can cause severe lower respiratory tract infection (LRI) and is a risk factor for the development of bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTx). Currently, the most widely used therapy for RSV is inhaled ribavirin. However, this therapy is costly and cumbersome. We investigated the utility of using oral ribavirin for the treatment of RSV infection after LTx. Methods: RSV was identified in nasopharyngeal swabs (NPS) or bronchoalveolar lavage (BAL) using direct fluorescent antibody (DFA) in 5 symptomatic LTx patients diagnosed with LRI. Data were collected from December 2005 and August 2007 and included: age; gender; type of LTx; underlying disease; date of RSV; pulmonary function prior to, during and up to 565 days post-RSV infection; need for mechanical ventilation; concurrent infections; and radiographic features. Patients received oral ribavirin for 10 days with solumedrol (10 to 15 mg/kg/day intravenously) for 3 days, until repeat NPS were negative. Results: Five patients had their RSV-LRI diagnosis made at a median of 300 days post-LTx. Mean forced expiratory volume in 1 second (FEV1) fell 21% (p < 0.012) during infection. After treatment, FEV1 returned to baseline and was maintained at follow-up of 565 days. There were no complications and no deaths with oral therapy. A 10-day course of oral ribavirin cost $700 compared with $14,000 for nebulized ribavirin at 6 g/day. Conclusions: Treatment of RSV after LTx with oral ribavirin and corticosteroids is well tolerated, effective and less costly than inhaled ribavirin. Further studies are needed to directly compare the long-term efficacy of oral vs nebulized therapy for RSV.