Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome

Abstract

Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies. Most studies were at serious or critical RoB; no studies were at low RoB. One study, at moderate RoB, showed reduced mortality rates in severe MERS patients with extracorporeal membrane oxygenation; no other studies showed a significant lifesaving benefit to any treatment. The existing literature on treatments for MERS is observational and at moderate to critical RoB. Clinical trials are needed to guide treatment decisions.

Keywords: CoV; MERS; Middle East respiratory syndrome; acute respiratory distress syndrome; antivirals; convalescent plasma; coronavirus; coronavirus infections; corticosteroids; interferon; intravenous immunoglobulin; respiratory infections; ribavirin; severe acute respiratory syndrome; supportive care; systematic review; viruses; zoonoses.

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram of literature search results, screening performed, and reasons for exclusion of full text reviews from a systematic review of evidence for MERS treatment with pharmacologic and supportive therapies. CINAHL, Cumulative Index to Nursing and Allied Health Literature.