SARS: Systematic Review of Treatment Effects
TLDR
It was not possible to determine whether treatments benefited patients during the SARS outbreak, but clinical trials should be designed to validate a standard protocol for dosage and timing and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment.Abstract:
Background
The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options The World Health Organization ( WHO) expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research
Methods and Findings
In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r), type I interferon (IFN), intravenous immunoglobulin ( IVIG), and SARS convalescent plasma from both in vitro studies and in SARS patients We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials ( CENTRAL) up to February 2005 Data from publications were extracted and evidence within studies was classified using predefined criteria In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm
Conclusions
Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak Some may have been harmful Clinical trials should be designed to validate a standard protocol for dosage and timing, and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatmentread more
Citations
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