Clinical outcomes of current medical approaches for Middle East respiratory syndrome: A systematic review and meta-analysis

Abstract

Middle East respiratory syndrome (MERS) is a respiratory disease caused by MERS coronavirus. Because of lack of vaccination, various studies investigated the therapeutic efficacy of antiviral drugs and supportive remedies. A systematic literature search from 10 databases was conducted and screened for relevant articles. Studies reporting information about the treatment of MERS coronavirus infection were extracted and analyzed. Despite receiving treatment with ribavirin plus IFN, the case fatality rate was as high as 71% in the IFN-treatment group and exactly the same in patients who received supportive treatment only. Having chronic renal disease, diabetes mellitus and hypertension increased the risk of mortality (P < .05), and chronic renal disease is the best parameter to predict the mortality. The mean of survival days from onset of illness to death was 46.6 (95% CI, 30.5-62.6) for the IFN group compared with 18.8 (95% CI, 10.3-27.4) for the supportive-only group (P = .001). Delay in starting treatment, older age group, and preexisting comorbidities are associated with worse outcomes. In conclusion, there is no difference between IFN treatment and supportive treatment for MERS patients in terms of mortality. However, ribavirin and IFN combination might have efficacious effects with timely administration and monitoring of adverse events. Large-scale prospective randomized studies are required to assess the role of antiviral drugs for the treatment of this high mortality infection.

Keywords: MERS-CoV; Middle East respiratory syndrome; interferon; systematic review.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram of studies' screening and selection according to inclusion and exclusion criteria

Figure 2

Forest plot meta‐analysis of 8 studies regarding the mortality rate of patients with MERS. CI, Confidence interval; P, probability value

Figure 3

The classification and regression tree model of 29 cases with individual data. A, Chronic renal disease was the best prediction variable for mortality rate. B, Inotropes was best prediction variable for renal replacement therapy

Figure 4

Kaplan‐Meier survival curves showing death days over time in IFN‐treated patients and supportive‐only groups. A, Death days from hospital admission to death for 44 cases (P = .977) and, B, death days from onset of illness to death for 13 cases (P = .001)