Middle East respiratory syndrome coronavirus infection medical therapy: Difference between revisions
Joao Silva (talk | contribs) |
Joao Silva (talk | contribs) |
||
| Line 15: | Line 15: | ||
*'''Convalescent [[plasma]]''' - this therapy, along with others that involve [[antibodies]] for the [[MERS-CoV]] has the strongest evidence for intervention. [[Plasma]] from patients who recovered from [[MERS-CoV]] [[infection]] contains neutralizing [[antibodies]], which represents the best therapy to neutralize the [[extracellular]] [[virus]]. | *'''Convalescent [[plasma]]''' - this therapy, along with others that involve [[antibodies]] for the [[MERS-CoV]] has the strongest evidence for intervention. [[Plasma]] from patients who recovered from [[MERS-CoV]] [[infection]] contains neutralizing [[antibodies]], which represents the best therapy to neutralize the [[extracellular]] [[virus]]. | ||
*'''[[Intravenous immunoglobulin]]''' - | *'''[[Intravenous immunoglobulin]]''' - | ||
*'''[[Interferon]]''' - | *'''[[Interferon]]''' - | ||
*'''[[HIV]] [[Protease inhibitors|Protease Inhibitors]]''' - | *'''[[HIV]] [[Protease inhibitors|Protease Inhibitors]]''' - | ||
*'''[[Corticosteroids]]''' - | *'''[[Corticosteroids]]''' - | ||
*'''[[Ribavirin]]''' - the most commonly used [[drug]] in the treatment of [[SARS]]. Due to its high level of [[toxicity]] and lack of evidence of therapeutical activity for [[MERS-CoV]] in humans, some experts recommend the withhold of [[ribavirin]]. | |||
==References== | ==References== | ||
Revision as of 22:52, 17 June 2014
|
Middle East Respiratory Syndrome Coronavirus Infection Microchapters |
|
Differentiating Middle East Respiratory Syndrome Coronavirus Infection from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Middle East respiratory syndrome coronavirus infection medical therapy On the Web |
|
American Roentgen Ray Society Images of Middle East respiratory syndrome coronavirus infection medical therapy |
|
FDA on Middle East respiratory syndrome coronavirus infection medical therapy |
|
CDC on Middle East respiratory syndrome coronavirus infection medical therapy |
|
Middle East respiratory syndrome coronavirus infection medical therapy in the news |
|
Blogs on Middle East respiratory syndrome coronavirus infection medical therapy |
|
Directions to Hospitals Treating Middle East respiratory syndrome coronavirus infection |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness. It is caused by an emerging coronavirus, specifically a betacoronavirus called MERS-CoV (Middle East Respiratory Syndrome Coronavirus), first discovered in 2012. Being a relatively novel virus, treatment options are very limited, with no antiviral therapy approved for treating patients yet. Outbreaks of MERS-CoV represent a great challenge since there is very limited time to develop and test new pharmaceutical drugs. Up until now, supportive medical care, along with untested convalescent plasma, have been the only treatment options. However, reuse of drugs for other viruses is presenting as an attractive alternative for MERS-CoV.[1]
Medical Therapy
MERS represents a great challenge in terms of treatment because it is caused by a relatively novel virus to which there is no approved therapy yet. According to the International Severe Acute Respiratory & Emerging Infection Consortium (ISARIC), supportive medical care continues to be the approved treatment for MERS. The search for broad-spectrum inhibitors aiming to minimize the impact of coronaviruses infections remains the major goal. Recent studies are showing the potential use of other drugs and therapies to treat the MERS-CoV, which are based on the experience of treating other coronaviruses like the SARS virus. This repurposing of drugs has advantages such as: better availability, lower cost and known safety and tolerability profiles. However, lack of evidence makes these new therapies uncertain.[1]
Cell and animal studies have shown conflicting results: the combination of ribavirin with interferon α-2b in a cell study reduced viral replication[2]; in another study with rhesus monkeys, the combination of intramuscular ribavirin with interferon α-2b, the group that received the treatment did not develop breathing abnormalities nor radiographic evidence of pneumonia[3]; however, when tried in 5 critically ill patients in Saudi Arabia, this combination was inefficient in all patients, leading to a fatal outcome.[4]
Despite the absence of a specific therapy, some approaches are considered to be more worth of experimentation than others. These include:[5][6][7][8]
- Convalescent plasma - this therapy, along with others that involve antibodies for the MERS-CoV has the strongest evidence for intervention. Plasma from patients who recovered from MERS-CoV infection contains neutralizing antibodies, which represents the best therapy to neutralize the extracellular virus.
- Intravenous immunoglobulin -
- Interferon -
- HIV Protease Inhibitors -
- Corticosteroids -
- Ribavirin - the most commonly used drug in the treatment of SARS. Due to its high level of toxicity and lack of evidence of therapeutical activity for MERS-CoV in humans, some experts recommend the withhold of ribavirin.
References
- ↑ 1.0 1.1 Dyall J, Coleman CM, Hart BJ, Venkataraman T, Holbrook MR, Kindrachuk J; et al. (2014). "Repurposing of clinically developed drugs for treatment of Middle East Respiratory Coronavirus Infection". Antimicrob Agents Chemother. doi:10.1128/AAC.03036-14. PMID 24841273.
- ↑ Falzarano D, de Wit E, Martellaro C, Callison J, Munster VJ, Feldmann H (2013). "Inhibition of novel β coronavirus replication by a combination of interferon-α2b and ribavirin". Sci Rep. 3: 1686. doi:10.1038/srep01686. PMC 3629412. PMID 23594967.
- ↑ Falzarano D, de Wit E, Rasmussen AL, Feldmann F, Okumura A, Scott DP; et al. (2013). "Treatment with interferon-α2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques". Nat Med. 19 (10): 1313–7. doi:10.1038/nm.3362. PMID 24013700.
- ↑ Al-Tawfiq JA, Momattin H, Dib J, Memish ZA (2014). "Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational study". Int J Infect Dis. 20: 42–6. doi:10.1016/j.ijid.2013.12.003. PMID 24406736.
- ↑ "Treatment of MERS-CoV: Decision Support Tool".
- ↑ Guery B, van der Werf S (2013). "Coronavirus: need for a therapeutic approach". Lancet Infect Dis. 13 (9): 726–7. doi:10.1016/S1473-3099(13)70153-1. PMID 23782860.
- ↑ Ren Z, Yan L, Zhang N, Guo Y, Yang C, Lou Z; et al. (2013). "The newly emerged SARS-like coronavirus HCoV-EMC also has an "Achilles' heel": current effective inhibitor targeting a 3C-like protease". Protein Cell. 4 (4): 248–50. doi:10.1007/s13238-013-2841-3. PMID 23549610.
- ↑ "WHO-ISARIC joint MERS-CoV Outbreak Readiness Workshop: Clinical management and potential use of convalescent plasma" (PDF).