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A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
Travel Med Infect Dis. 2019 Jul - Aug; 30:9-18.TM

Abstract

BACKGROUND

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first described in 2012 and attracted a great international attention due to multiple healthcare associated outbreaks. The disease carries a high case fatality rate of 34.5%, and there is no internationally or nationally recommended therapy.

METHOD

We searched MEDLINE, Science Direct, Embase and Scopus databases for relevant papers published till March 2019 describing in vitro, in vivo or human therapy of MERS.

RESULTS

Initial search identified 62 articles: 52 articles were from Medline, 6 from Embase, and 4 from Science Direct. Based on the inclusions and exclusions criteria, 30 articles were included in the final review and comprised: 22 in vitro studies, 8 studies utilizing animal models, 13 studies in humans, and one study included both in vitro and animal model. There are a few promising therapeutic agents on the horizon. The combination of lopinavir/ritonavir and interferon-beta- 1b showed excellent results in common marmosets and currently is in a randomized control trial. Ribavirin and interferon were the most widely used combination and experience comes from a number of observational studies. Although, the data are heterogenous, this combination might be of potential benefit and deserve further investigation. There were no randomized clinical trials to recommend specific therapy for the treatment of MERS-CoV infection. Only one such study is planned for randomization and is pending completion. The study is based on a combination of lopinavir/ritonavir and interferon-beta- 1b. A fully human polyclonal IgG antibody (SAB-301) was safe and well tolerated in healthy individuals and this agent may deserve further testing for efficacy.

CONCLUSION

Despite multiple studies in humans there is no consensus on the optimal therapy for MERS-CoV. Randomized clinical trials are needed and potential therapies should be evaluated only in such clinical trials. In order to further enhance the therapeutic aroma for MERS-CoV infection, repurposing old drugs against MERS-CoV is an interesting strategy and deserves further consideration and use in clinical settings.

Links

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Authors+Show Affiliations

Momattin H
Department of Pharmacy Services, King Khalid Hospital, Najran, Saudi Arabia.
Al-Ali AY
Department of Pharmacy Services, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia.
Al-Tawfiq JA
Infectious Disease Unit, Specialty Internal Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaffar.tawfiq@jhah.com.

MeSH

AnimalsAntiviral AgentsCoronavirus InfectionsDrug CombinationsHumansImmunoglobulin GInterferon-betaLopinavirMiddle East Respiratory Syndrome CoronavirusRitonavir

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

31252170

Clinical Trial Links

Primary Prevention of Infection by COVID-19 in Workers

Citation

Momattin, Hisham, et al. "A Systematic Review of Therapeutic Agents for the Treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV)." Travel Medicine and Infectious Disease, vol. 30, 2019, pp. 9-18.
Momattin H, Al-Ali AY, Al-Tawfiq JA. A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis. 2019;30:9-18.
Momattin, H., Al-Ali, A. Y., & Al-Tawfiq, J. A. (2019). A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Medicine and Infectious Disease, 30, 9-18. https://doi.org/10.1016/j.tmaid.2019.06.012
Momattin H, Al-Ali AY, Al-Tawfiq JA. A Systematic Review of Therapeutic Agents for the Treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Travel Med Infect Dis. 2019 Jul - Aug;30:9-18. PubMed PMID: 31252170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Systematic Review of therapeutic agents for the treatment of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). AU - Momattin,Hisham, AU - Al-Ali,Anfal Y, AU - Al-Tawfiq,Jaffar A, Y1 - 2019/06/25/ PY - 2019/03/03/received PY - 2019/06/23/revised PY - 2019/06/24/accepted PY - 2019/6/30/pubmed PY - 2019/10/28/medline PY - 2019/6/29/entrez KW - MERS KW - Middle east respiratory syndrome coronavirus KW - Therapy SP - 9 EP - 18 JF - Travel medicine and infectious disease JO - Travel Med Infect Dis VL - 30 N2 - BACKGROUND: The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was first described in 2012 and attracted a great international attention due to multiple healthcare associated outbreaks. The disease carries a high case fatality rate of 34.5%, and there is no internationally or nationally recommended therapy. METHOD: We searched MEDLINE, Science Direct, Embase and Scopus databases for relevant papers published till March 2019 describing in vitro, in vivo or human therapy of MERS. RESULTS: Initial search identified 62 articles: 52 articles were from Medline, 6 from Embase, and 4 from Science Direct. Based on the inclusions and exclusions criteria, 30 articles were included in the final review and comprised: 22 in vitro studies, 8 studies utilizing animal models, 13 studies in humans, and one study included both in vitro and animal model. There are a few promising therapeutic agents on the horizon. The combination of lopinavir/ritonavir and interferon-beta- 1b showed excellent results in common marmosets and currently is in a randomized control trial. Ribavirin and interferon were the most widely used combination and experience comes from a number of observational studies. Although, the data are heterogenous, this combination might be of potential benefit and deserve further investigation. There were no randomized clinical trials to recommend specific therapy for the treatment of MERS-CoV infection. Only one such study is planned for randomization and is pending completion. The study is based on a combination of lopinavir/ritonavir and interferon-beta- 1b. A fully human polyclonal IgG antibody (SAB-301) was safe and well tolerated in healthy individuals and this agent may deserve further testing for efficacy. CONCLUSION: Despite multiple studies in humans there is no consensus on the optimal therapy for MERS-CoV. Randomized clinical trials are needed and potential therapies should be evaluated only in such clinical trials. In order to further enhance the therapeutic aroma for MERS-CoV infection, repurposing old drugs against MERS-CoV is an interesting strategy and deserves further consideration and use in clinical settings. SN - 1873-0442 UR - https://www.unboundmedicine.com/medline/citation/31252170/A_Systematic_Review_of_therapeutic_agents_for_the_treatment_of_the_Middle_East_Respiratory_Syndrome_Coronavirus__MERS_CoV__ DB - PRIME DP - Unbound Medicine ER -