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Antiviral Treatments and Advanced Supportive Care for Middle East Respiratory Syndrome: A Systematic Review
CCCF Academy. Kain T. 11/13/19; 283452; EP123
Dr. Taylor Kain
Dr. Taylor Kain
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ePoster
Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Taylor Kain,[1] Patrick Lindsay,[2] Yaseen Arabi,[3] Neill Adhikari,1,4 and Robert Fowler1,[4]

 
[1] Department of Critical Care, University of Toronto, Toronto ON
[2] Department of Medicine, University of Toronto
[3] King Saud bin Abdulaziz, University for Health Sciences, Riyadh Saudi Arabia
[4] Sunnybrook Health Sciences Centre, Toronto ON

Introduction: Middle Eastern Respiratory Syndrome (MERS) was first reported in September 2012 in Saudi Arabia. Now known to be caused by MERS coronavirus (MERS-CoV), it has spread to over 27 countries and as of May 1, 2019 the WHO has reported 2449 confirmed cases, with 845 deaths (case fatality rate of 34.5%).[i] There are no antiviral treatments known to be effective against MERS-CoV infection, but limited data in animal and cell line models have led to multiple different combinations of antivirals being suggested.

Objectives: Our aim was to examine all treatments for MERS-CoV trialed in humans, and to summarize their effects on mortality to guide further investigations and provide guidance for treatment decisions in front-line health care providers.
 
Methods: We developed a prospective register of systematic reviews (PROSPERO) (reference CRD42018114622) protocol based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) design. In August 2018 we conducted a database review of 9 databases including MEDLINE, PubMed, Scopus, Embase, Cochrane, CINHAHL, WHO Global Health Library, Wed of Science, and New York Academy of Medicine Grey Literature Report (NYAMGLR). Covidence was used for abstract and full text review, and data was extracted manually. Risk of bias was assessed in duplicate using the ROBBINS-I tool.
 
Results: 7733 articles were retrieved; 4184 articles were duplicates leading to 3549 abstracts assessed, 16 studies met eligibility criteria. The studies reported on an estimated 467-540 unique cases between Sept 2012 and Oct 2015, which represents approximately 29.1-33.7% of all cases of MERS-CoV during that time period. 11 different specific therapies were studied. A single small study examining extra-corporeal membrane oxygenation (ECMO) was at low risk of bias and a showed a mortality benefit in severe MERS-CoV infection. All other studies were at moderate to high risk of bias as assessed by the ROBBINS-I tool. Diversity of different specific therapies trialed for MERS-CoV and substantial patient overlap in study patient data sets precluded formal meta-analysis of treatment effect for specific therapies.
 
Conclusions: We found that the existing literature assessing specific treatments for MERS-CoV are largely observational and at moderate to high risk of bias. Based upon this review, no specific therapies can yet be recommended. Supportive care is the suggested mainstay of treatment with a single observational study at low risk of bias showing a mortality reduction with use of extra-corporeal life support for treatment of severe MERS-CoV. Further studies that adjust for potential confounding, in addition to well-conducted randomize clinical trials, are urgently needed to guide treatment for this viral infection carrying a high mortality rate.

 

[i] World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV). [ONLINE] Available at: https://www.who.int/emergencies/mers-cov/en/. [Accessed July 29, 2019].
 
 
 
 
 

Image Image

World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV). [ONLINE] Available at: https://www.who.int/emergencies/mers-cov/en/. [Accessed July 29, 2019].

Sterne JAC, Higgins JPT, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. 

ePoster
Topic: Systematic Review, Meta-Analysis, or Meta-Synthesis

Taylor Kain,[1] Patrick Lindsay,[2] Yaseen Arabi,[3] Neill Adhikari,1,4 and Robert Fowler1,[4]

 
[1] Department of Critical Care, University of Toronto, Toronto ON
[2] Department of Medicine, University of Toronto
[3] King Saud bin Abdulaziz, University for Health Sciences, Riyadh Saudi Arabia
[4] Sunnybrook Health Sciences Centre, Toronto ON

Introduction: Middle Eastern Respiratory Syndrome (MERS) was first reported in September 2012 in Saudi Arabia. Now known to be caused by MERS coronavirus (MERS-CoV), it has spread to over 27 countries and as of May 1, 2019 the WHO has reported 2449 confirmed cases, with 845 deaths (case fatality rate of 34.5%).[i] There are no antiviral treatments known to be effective against MERS-CoV infection, but limited data in animal and cell line models have led to multiple different combinations of antivirals being suggested.

Objectives: Our aim was to examine all treatments for MERS-CoV trialed in humans, and to summarize their effects on mortality to guide further investigations and provide guidance for treatment decisions in front-line health care providers.
 
Methods: We developed a prospective register of systematic reviews (PROSPERO) (reference CRD42018114622) protocol based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) design. In August 2018 we conducted a database review of 9 databases including MEDLINE, PubMed, Scopus, Embase, Cochrane, CINHAHL, WHO Global Health Library, Wed of Science, and New York Academy of Medicine Grey Literature Report (NYAMGLR). Covidence was used for abstract and full text review, and data was extracted manually. Risk of bias was assessed in duplicate using the ROBBINS-I tool.
 
Results: 7733 articles were retrieved; 4184 articles were duplicates leading to 3549 abstracts assessed, 16 studies met eligibility criteria. The studies reported on an estimated 467-540 unique cases between Sept 2012 and Oct 2015, which represents approximately 29.1-33.7% of all cases of MERS-CoV during that time period. 11 different specific therapies were studied. A single small study examining extra-corporeal membrane oxygenation (ECMO) was at low risk of bias and a showed a mortality benefit in severe MERS-CoV infection. All other studies were at moderate to high risk of bias as assessed by the ROBBINS-I tool. Diversity of different specific therapies trialed for MERS-CoV and substantial patient overlap in study patient data sets precluded formal meta-analysis of treatment effect for specific therapies.
 
Conclusions: We found that the existing literature assessing specific treatments for MERS-CoV are largely observational and at moderate to high risk of bias. Based upon this review, no specific therapies can yet be recommended. Supportive care is the suggested mainstay of treatment with a single observational study at low risk of bias showing a mortality reduction with use of extra-corporeal life support for treatment of severe MERS-CoV. Further studies that adjust for potential confounding, in addition to well-conducted randomize clinical trials, are urgently needed to guide treatment for this viral infection carrying a high mortality rate.

 

[i] World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV). [ONLINE] Available at: https://www.who.int/emergencies/mers-cov/en/. [Accessed July 29, 2019].
 
 
 
 
 

Image Image

World Health Organization. Middle East Respiratory Syndrome Coronavirus (MERS-CoV). [ONLINE] Available at: https://www.who.int/emergencies/mers-cov/en/. [Accessed July 29, 2019].

Sterne JAC, Higgins JPT, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. 

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