Antiviral treatment of SARS: can we draw any conclusions?

Now that a novel coronavirus has been well established as the cause of severe acute respiratory syndrome (SARS),1,2 it is important to evaluate what we have learned about the antiviral therapy of SARS. Is ribavirin effective? What other antiviral agents have been tried? What do we know about their efficacy and safety? What antiviral regimens should be applied if further outbreaks occur? In the single randomized clinical study, Zhao and coworkers10 randomly assigned 190 patients admitted to hospital Feb. 2-14, 2003, to 1 of 3 groups (groups A through C); 60 patients admitted after Feb. 14 were assigned to group D. All the patients were from Guangdong province. There were 70 men and 120 women, ranging in age from 16 to 84 years (mean 28.6 #177;10.3). The diagnosis of SARS was made according to clinical and radiologic criteria. The patients were treated in 2 hospitals, and the study was not blinded. Demographic characteristics and severity of disease were similar among the groups. Patients in group A (n = 40) were treated with ribavirin 400-600 mg/d plus antibiotics for 10-14 days; patients in group B (n = 30) were treated with intravenous antibiotics plus interferon alpha (3 million IU/d), without ribavirin. Group A and B patients received no steroids in the first 14 days of treatment; when used, the methylprednisolone dosage was 80-160 mg/d. Patients in group C (n = 60) were treated with intravenous antibiotics, plus methylprednisolone (80-160 mg/d) if symptoms worsened; some also received interferon-[alpha]. Patients in group D (n = 60) were treated with antibiotics and, in 45 cases, interferon-[alpha]. Patients who were still febrile after 3 days were given high-dose (160-1000 mg/d) methylprednisolone. Although physicians are accustomed to having a vast armamentarium of pharmacologic choices in normal practice, those who treated cases of severe acute respiratory syndrome (SARS) this past year were confronted with a disease for which there was no clear treatment. Some reports showed that ribavirin and steroids were of some help, whereas others showed that such treatment had no effect on clinical outcomes. From a unique perspective as the editor-in-chief of the China Medical Tribune, Zhaori discusses our experience to date with antiviral dierapy in the treatment of SARS.