Hospital Pharmacy - August 2020 - 231

231

5
Single lung: 4
Bilateral lung transplant: 1

44
Lung transplant

8
Lung or heart/lung transplant

19
Lung transplant
50% of population of RBV
AER
17
Lung transplant
45% of population of RBV PO

Retrospective
cohort
2007-2009

Retrospective
cohort
1992-1997

Prospective
case control
2004

Retrospective
cohort
2006-2010

Retrospective
cohort
2013-2016

ArizaHeredia
et al23

Palmer
et al24

Zamora
et al25

Li et al26

Trang
et al27

RBV AER 6 g over 6 h qd
RBV PO 800 mg PO BID if weight ≥75 kg or 600 mg PO BID if weight
<75 kg
Hematologic malignancy and HSCT patients IVIG 500 mg/kg IV 3 times
weekly × 2 wk was given at the discretion of treating physician

Group A
RBV AER 2 g TID × 5 d + MP 10 mg/kg/d × 3 d, + RSV IVIG 500 mg/kg ×
1 dose OR PZB 15 mg/kg × 1 dose + IVIG 500 mg/kg × 1 dose (n = 33)
Group B
RBV AER 2 g TID × 5 d + MP 10 mg/kg/d × 3 d or group A therapy
started > 2 wk after symptom onset (n = 11)
Group C
Controls (not infected with RSV)
(case matched for indication for lung transplant and time from lung
transplant) (n = 33)
RBV AER 6 g over 12 h × 3-5 d ± IVIG, MP (10-15 mg/kg/d) (n = 8)
RBV 400 mg PO TID × 5-10 d ± IVIG, MP (10-15 mg/kg/d) (n = 4)

RBV AER (n = 4)
No treatment (n = 1)

RBV AER 6 g over 18 h × 30 d (n = 1)
RBV AER 6 g over 18 h × 10 d, PZB (n = 2)
RBV AER 6 g over 18 h + PZB, IVIG × unknown duration (n = 1)
RBV AER 6 g over 18 h × 7 d, RBV 400 mg PO every 8 h × 4 d (n = 1)
RBV PO × 5 d (n = 1)
RBV PO, PZB, IVIG × 5 d (n = 1)
(RBV PO dose ranged from 300 mg every 12 h to 600 mg every 8 h)
No therapy (n = 1)

Agent(s)
Duration of therapy

NR

NR

NR

NR

4.1 d
(range = 2-5 d)

Time from diagnosis
to start of RBV
Outcome(s)

*  In-hospital/30-d mortality RBV AER: 0% (0/8)
*  In-hospital/30-d mortality RBV PO: 0% (0/4)
*  Length of stay (included URTI and ambulatory patients)
 RBV AER: 5 ± 1.5 d
 RBV PO: 11 ± 15.1 d
*  BOS (included URTI and ambulatory patients)
 RBV AER: 3 patients baseline BOS 1 or greater at time
of infection, 2 patients had new onset or progression of
BOS at 6 mo
 RBV PO: no BOS reported
*  30-d mortality RBV AER: 5.3% (1/19)
*  30-d mortality RBV PO: 17.6% (3/17)
*  No patients required MV

*  In-hospital mortality RBV AER: 0% (0/5)
*  In-hospital mortality RBV PO: 50% (1/2)
*  In-hospital mortality no treatment: 0% (0/1)
*  In-hospital mortality RBV AER combination therapy: 0% (0/4)
*  In-hospital mortality RBV AER monotherapy: 0% (0/1)
*  MV mortality RBV PO: 50% (1/2)
*  MV mortality no treatment: 0% (0/1)
Outcome based on days after transplant:
*  ≤365 d: mortality: 1/5
*  365 d: mortality: 0/3
Organ rejection: 0% (0/8)
Length of stay RBV AER: 11 to 30 d
*  In-hospital mortality RBV AER: 25% (1/4)
*  MV mortality RBV AER:50% (1/2)
Outcome based on days post-transplant:
*  ≤365 d RBV AER: mortality: 50% (1/2)
*  365 d: RBV AER mortality: (0/2)
OB-RBV AER: 50% (2/4) mean follow-up 758 d
Group A
*  30-d mortality: 0% (0/33)
*  BOS: 21% (7/33) onset: 11.1 ± 8 mo
Group B
*  30-d mortality: 27% (3/11)
*  BOS: 100% (8/8), P < .05, onset: 6.8 ± 4 mo
Group C
*  30-d mortality: 0% (0/33)
*  BOS: 15% (5/33), onset: 14.1 ± 6 mo

ADEs

Nausea (n = 6) (not reported if
RBV PO or RBV AER)
Bronchospasm (n = 2) (RBV AER)
Thrombocytopenia/
decrease absolute lymphocyte
count (n = 1)
RBV PO

AER: no adverse events
encountered
PO: anemia within 2 wk (1)

NR

NR

AER: no adverse events
encountered
PO: hemolytic anemia (n = 1)
(occurred in patient who initially
received RBV AER) required
transfusion

Note. RBV = ribavirin; AER = aerosolized; RSV = respiratory syncytial virus; LRTI = lower respiratory tract infection; ADE = adverse drug event; PO = oral; PZB = palivizumab; IVIG = intravenous immunoglobulin; MV =
mechanical ventilation; NR = not reported; OB = obstructive bronchiolitis; TID = 3 times a day; BOS = bronchial obliterans syndrome; MP = methylprednisolone; URTI = upper respiratory tract infection; qd = every day;
BID = twice a day; HSCT = hematopoietic stem cell transplant; RSV IVIG = IVIG with RSV-neutralizing antibodies.

8
Lung: 2
Kidney: 2
Kidney/pancreas: 1
Liver: 3

Type of study

References

Number of participants
with LRTI

Table 3. RBV AER in Hospitalized Adult Solid Organ Transplant Recipients With RSV LRTI.
Hospital Pharmacy - August 2020

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