title: IFN-α2a or IFN-β1a in combination with ribavirin to treat Middle East respiratory syndrome coronavirus pneumonia: a retrospective study.
abstract: OBJECTIVE
  Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with significant mortality. We examined the utility of plasma MERS-CoV PCR as a prognostic indicator and compared the efficacies of IFN-α2a and IFN-β1a when combined with ribavirin in reducing MERS-CoV-related mortality rates.
  
  
  METHODS
  We retrospectively analysed 32 patients with confirmed MERS-CoV infection, admitted between April 2014 and June 2014, by positive respiratory sample RT-PCR. Plasma MERS-CoV RT-PCR was performed at the time of diagnosis for 19 patients.
  
  
  RESULTS
  The overall mortality rate was 69% (22/32). Ninety percent (9/10) of patients with positive plasma MERS-CoV PCR died compared with 44% (4/9) of those with negative plasma MERS-CoV PCR. Mortality rate in patients who received IFN-α2a was 85% (11/13) compared with 64% (7/11) in those who received IFN-β1a (P = 0.24). The mortality rate in patients with renal failure (14), including 8 on haemodialysis, was 100%. Age >50 years and diabetes mellitus were found to be significantly associated with mortality (OR = 26.1; 95% CI 3.58-190.76; P = 0.001 and OR = 15.74; 95% CI 2.46-100.67; P = 0.004, respectively). The median duration of viral shedding in patients who recovered was 11 days (range 6-38 days). Absence of fever was noted in 5/32 patients.
  
  
  CONCLUSIONS
  Plasma MERS-CoV RT-PCR may serve as an effective tool to predict MERS-CoV-associated mortality. Older age and comorbid conditions may have contributed to the lack of efficacy of IFN-α2a or IFN-β1a with ribavirin in treating MERS-CoV. Absence of fever should not exclude MERS-CoV.
authors.affiliation: Infectious Diseases Division, Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia sarah.shalhoub@googlemail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Shalhoub
authors.affiliation: King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Center (KAIMRC), Infection Prevention and Control, King Abdulaziz Medical City, Saudi Arabia.
authors.forename: Fayssal
authors.initials: F
authors.lastname: Farahat
authors.affiliation: Infection Prevention and Control, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Jiffri
authors.affiliation: Microbiology Laboratory, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
authors.forename: Raed
authors.initials: R
authors.lastname: Simhairi
authors.affiliation: Department of Critical Care, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
authors.forename: Omar
authors.initials: O
authors.lastname: Shamma
authors.affiliation: Department of Nephrology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
authors.forename: Nauman
authors.initials: N
authors.lastname: Siddiqi
authors.affiliation: Infectious Diseases Division, Department of Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
authors.forename: Adnan
authors.initials: A
authors.lastname: Mushtaq
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage*; D018352:Coronavirus Infections / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D016899:Interferon-beta / Q000008:administration & dosage*; D008168:Lung / Q000821:virology; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D010949:Plasma / Q000821:virology; D011024:Pneumonia, Viral / Q000188:drug therapy*; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin; D016899:Interferon-beta
keywords: MERS-CoV; interferon; treatment