title: Oral ribavirin for respiratory syncytial virus infection after lung transplantation: Efficacy and cost-efficiency.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) causes serious respiratory tract infections in lung transplant (LTx) recipients, is associated with development of bronchiolitis obliterans syndrome, and has no proven effective therapy. We evaluated the efficacy, safety, and cost-effectiveness of oral ribavirin for the treatment of RSV infection after LTx.
  
  
  METHODS
  Between December 2011 and May 2014, 52 LTx recipients developed 56 episodes of symptomatic RSV infection, which was diagnosed by positive RSV polymerase chain reaction on nasopharyngeal swabs. An intravenous (IV) loading dose of ribavirin (33 mg/kg) was given in 52 of 56 episodes; an equivalent oral loading dose was given in 2 episodes. Oral ribavirin (20 mg/kg/day) was given by day 2 in 53 of 56 episodes. Median duration of therapy was 8 days (range 6-31 days).
  
  
  RESULTS
  Mean forced expiratory volume in 1 sec decreased from 2.38 ± 0.78 liters to 2.07 ± 0.85 liters (p < 0.001) at presentation, recovered to 2.26 ± 0.82 liters at cessation of ribavirin, and was maintained at 2.31 ± 0.81 liters within 3 months. New-onset bronchiolitis obliterans syndrome developed in 1 of 38 patients (2.6%) at 3 months. Anemia worsened in 23 episodes, and de novo anemia developed in 5 episodes. Mean hemoglobin decreased from 118 ± 16 g/liter to 113 ± 21 g/liter (p = 0.015). There were 4 late deaths. Compared with IV therapy, mean drug cost saving was US $6,035 per episode, and mean inpatient bed days was reduced by 6.7 days (p < 0.001).
  
  
  CONCLUSIONS
  To our knowledge, we report the largest series of LTx recipients treated with oral ribavirin for RSV. Oral ribavirin appears to be an effective, well-tolerated alternative to IV or inhaled ribavirin; provides considerable cost savings and reduces length of hospital stay. Potential long-term benefits in preventing development of chronic lung allograft dysfunction are yet to be determined.
authors.affiliation: Department of Pharmacy; Lung Transplant Unit. Electronic address: fay.burrows@svha.org.au.
authors.forename: Fay S
authors.initials: FS
authors.lastname: Burrows
authors.affiliation: Department of Pharmacy; Lung Transplant Unit.
authors.forename: Lilibeth M
authors.initials: LM
authors.lastname: Carlos
authors.affiliation: Lung Transplant Unit.
authors.forename: Mark
authors.initials: M
authors.lastname: Benzimra
authors.affiliation: Department of Microbiology and Clinical Infectious Diseases, St. Vincent's Hospital, Sydney, New South Wales, Australia.
authors.forename: Deborah J E
authors.initials: DJ
authors.lastname: Marriott
authors.affiliation: Lung Transplant Unit.
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Havryk
authors.affiliation: Lung Transplant Unit.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Plit
authors.affiliation: Lung Transplant Unit.
authors.forename: Monique A
authors.initials: MA
authors.lastname: Malouf
authors.affiliation: Lung Transplant Unit.
authors.forename: Allan R
authors.initials: AR
authors.lastname: Glanville
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000191:economics; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000191:economics; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000191:economics; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: CLAD; Lung transplantation; RSV; ribavirin