Abstract
Ribavirin has been used widely to treat Lassa fever in West Africa since the 1980s. However, few studies have systematically appraised the evidence for its use. We conducted a systematic review of published and unpublished literature retrieved from electronic databases and gray literature from inception to March 8, 2022. We identified 13 studies of the comparative effectiveness of ribavirin versus no ribavirin treatment on mortality outcomes, including unpublished data from a study in Sierra Leone provided through a US Freedom of Information Act request. Although ribavirin was associated with decreased mortality rates, results of these studies were at critical or serious risk for bias when appraised using the ROBINS-I tool. Important risks for bias related to lack of control for confounders, immortal time bias, and missing outcome data. Robust evidence supporting the use of ribavirin in Lassa fever is lacking. Well-conducted clinical trials to elucidate the effectiveness of ribavirin for Lassa fever are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 1559-1568 |
| Number of pages | 10 |
| Journal | Emerging Infectious Diseases |
| Volume | 28 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - Aug 2022 |
Bibliographical note
Funding Information:This review was supported by the World Health Organization (reference no. 2019/890244-1). H.C., S.D., J.S., and J.A.C.S. received financial support. The funder played no role in the conduct of this review. L.A.M. is supported by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-048). C.E.F. is supported by the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in partnership with the UK Health Security Agency. J.S. is partly supported by the NIHR Applied Research Collaboration West. The UK Public Health Rapid Support Team (A.P.S.) is funded by UK Aid from the Department of Health and Social Care and is jointly run by UK Health Security Agency and the London School of Hygiene & Tropical Medicine. P.W.H. is supported by the Wellcome Trust (grant no. 215091/Z/18/Z), the Bill and Melinda Gates Foundation (grant no. OPP1209135), and the EDCTP2 Programme supported by the European Union (ALERRT: RIA2016E-1612). J.A.C.S. is supported by the NIHR Bristol Biomedical Research Centre and by Health Data Research UK South West.
Publisher Copyright:
© 2022 Centers for Disease Control and Prevention (CDC). All rights reserved.
Keywords
- Africa, Western
- Humans
- Lassa Fever/drug therapy
- Lassa virus/genetics
- Ribavirin/therapeutic use
- Sierra Leone
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