Ribavirin use for respiratory syncytial virus (RSV) infection in patients with haematologic malignancies (HM) and haematopoietic stem cell transplant (HSCT) recipients remains controversial.
To ...summarize the current evidence of ribavirin treatment in association with mortality and progression to lower respiratory tract infection (LRTI) among patients with HM/HSCT with RSV infection.
MEDLINE, Embase, and the Institute for Scientific Information Web of Science.
Randomized controlled trials and observational studies investigating the effects of ribavirin, compared with treatment without ribavirin, for RSV infection.
Patients with HM/HSCT.
Ribavirin versus no ribavirin.
The risk of bias in non-randomized studies of exposure (ROBIN-E).
The random-effects model was used to calculate the pooled OR (pOR) with 95% CI for the pooled effect estimates of ribavirin benefits. Grading of recommendation assessment, development, and evaluation was used to evaluate the certainty of evidence.
One randomized controlled trial and 14 observational studies were included, representing 1125 patients with HM/HSCT. Ribavirin use was not associated with lower all-cause or RSV-associated mortality with pORs 95% CI of 0.81 0.40, 1.66, I2 = 55% (low certainty of evidence) and 0.48 0.11, 2.15, I2 = 64% (very low certainty of evidence), respectively. In subgroup analyses, ribavirin use was associated with lower mortality in patients with HM/HSCT with LRTI with pOR 95% CI of 0.19 0.07, 0.51, I2 = 0% (moderate certainty of evidence). In subgroup analyses among studies providing adjusted OR, ribavirin use was associated with lower all-cause mortality with pOR of 0.41 0.23, 0.74, I2 = 0% (moderate certainty of evidence). In addition, aerosolized ribavirin was associated with lower progression to LRTI with pOR 95% CI of 0.27 0.09, 0.80, I2 = 71% (low certainty of evidence).
Ribavirin may be a reasonable option to treat RSV in patients with HM/HSCT in the absence of other effective antiviral agents.
Abstract
Coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) is a safe and effective treatment for COVID-19 in immunocompromised (IC) patients. IC patients have a higher risk of persistent ...infection, severe disease, and death from COVID-19. Despite the continued clinical use of CCP to treat IC patients, the optimal dose, frequency/schedule, and duration of CCP treatment has yet to be determined, and related best practices guidelines are lacking. A group of individuals with expertise spanning infectious diseases, virology and transfusion medicine was assembled to render an expert opinion statement pertaining to the use of CCP for IC patients. For optimal effect, CCP should be recently and locally collected to match circulating variant. CCP should be considered for the treatment of IC patients with acute and protracted COVID-19; dosage depends on clinical setting (acute vs protracted COVID-19). CCP containing high-titer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, retains activity against circulating SARS-CoV-2 variants, which have otherwise rendered monoclonal antibodies ineffective.
This viewpoint offers expert guidance for the use of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) to treat immunocompromised patients with acute or protracted COVID-19, addressing indications, dosage, frequency/schedule, and duration of treatment, along with the evidence and associated challenges of use.
COVID‐19 has profoundly affected the American health care system; its effect on the liver transplant (LT) waitlist based on COVID‐19 incidence has not been characterized. Using SRTR data, we compared ...observed LT waitlist registrations, waitlist mortality, deceased donor LTs (DDLT), and living donor LTs (LDLT) 3/15/2020‐8/31/2020 to expected values based on historical trends 1/2016‐1/2020, stratified by statewide COVID‐19 incidence. Overall, from 3/15 to 4/30, new listings were 11% fewer than expected (IRR = 0.84 0.890.93), LDLTs were 49% fewer (IRR = 0.37 0.510.72), and DDLTs were 9% fewer (IRR = 0.85 0.910.97). In May, new listings were 21% fewer (IRR = 0.74 0.790.84), LDLTs were 42% fewer (IRR = 0.39 0.580.85) and DDLTs were 13% more (IRR = 1.07 1.151.23). Centers in states with the highest incidence 3/15‐4/30 had 59% more waitlist deaths (IRR = 1.09 1.592.32) and 34% fewer DDLTs (IRR = 0.50 0.660.86). By August, waitlist outcomes were occurring at expected rates, except for DDLT (13% more across all incidences). While the early COVID‐affected states endured major transplant practice changes, later in the pandemic the newly COVID‐affected areas were not impacted to the same extent. These results speak to the adaptability of the transplant community in addressing the pandemic and applying new knowledge to patient care.
This registry‐based study of liver transplantation in the United States describes the substantial impact of the COVID‐19 pandemic on waitlist events over time and highlights the resiliency of the transplant community.
Influenza is a major cause of morbidity and sometimes mortality in immunocompromised patients, including solid-organ transplant (SOT) recipients. Current guidelines call for influenza immunization of ...SOT recipients from 3 months posttransplant onward; the stated reason for delaying immunization in the early posttransplant period is an efficacy rather than a safety issue. Despite concerns about possible rejection raised in small case series and studies of alloimmune responses in immunized patients, virtually all larger clinical studies have shown no increased risk of rejection or allograft dysfunction after influenza vaccination.
Further evidence, mostly supporting the safety of influenza vaccine, has been published during the past 2 years. For example, one study using a large database of 51,730 adult Medicare primary renal transplant recipients showed that influenza vaccination was actually associated with a lower risk of graft loss and death. It appears that actual influenza infection itself, rather than the vaccine, carries a risk of allograft dysfunction.
At this time, influenza vaccine after SOT is considered clinically safe, and current evidence supports the guidelines' recommendations to immunize. The issue of optimal timing for efficacy still remains to be resolved. In addition, educational tools for increasing the acceptance of influenza vaccine in healthcare workers and family members are described.
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