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Clin Infect Dis. 2018 Sep 8. doi: 10.1093/cid/ciy760. [Epub ahead of print]

Oral versus Aerosolized Ribavirin for the Treatment of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplantation Recipients.

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Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern Medical School, Houston, Texas, USA.
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.



The use of oral ribavirin (ORBV) for respiratory syncytial virus (RSV) infections is not well studied. With the drastic increase in the cost of aerosolized ribavirin (ARBV), we aimed to compare outcomes of hematopoietic cell transplantation (HCT) recipients treated with ORBV or ARBV for RSV infections.


We reviewed the records of 124 HCT recipients with RSV infections treated with ORBV or ARBV from September 2014 through April 2017. An immunodeficiency scoring index (ISI) was used to classify patients as low, moderate, or high risk for progression to lower respiratory tract infection (LRI) or death.


Seventy patients (56%) received ARBV and 54 (44%) ORBV. Both groups had a 27% rate of progression to LRI (p=1.00). Mortality rates did not significantly differ between groups (30-day: aerosolized 10%, oral 9%, p=1.00; 90-day: aerosolized 23%, oral 11%, p=0.10). Classification and regression tree analysis identified ISI ≥7 as an independent predictor of 30-day mortality. For patients with ISI ≥7, 30-day mortality was significantly increased overall, yet remained similar between the aerosolized and oral therapy groups (33% for both). After propensity score adjustment, Cox proportional hazards models showed similar mortality rates between oral and aerosolized therapy groups (30-day: hazard ratio 1.12, 95% confidence interval 0.345-3.65, p=0.845; 90-day: hazard ratio 0.52, 95% confidence interval 0.192-1.411, p=0.199).


HCT recipients with RSV infections had similar outcomes when treated with ARBV or ORBV. Oral ribavirin may be an effective alternative to aerosolized ribavirin for treatment of RSV in HCT recipients, with potential significant cost savings.


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