Department of Internal Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Sihhiye 06100, Ankara, Turkey.
J Antimicrob Chemother. 2011 Jun;66(6):1215-22. doi: 10.1093/jac/dkr136. Epub 2011 Apr 11.
Crimean-Congo haemorrhagic fever (CCHF) is a potentially fatal tick-borne infection. The virus is widely distributed around the world and reports of sporadic cases and outbreaks have recently increased significantly. Some authors have proposed that ribavirin improves survival in CCHF and this view appears to be widely accepted.
We evaluated the efficacy of ribavirin in reducing mortality by conducting a systematic review and meta-analysis. We included randomized controlled trials and observational studies that compared the outcomes of CCHF patients who were treated with ribavirin with those of patients that were not treated. The main endpoint we assessed was survival. We also evaluated secondary endpoints, i.e. adverse events, length of stay in the hospital, time taken for laboratory values to return to normal and requirement for blood products. A pooled estimate of the relative risks for survival from each study was obtained by using random effects models.
One randomized controlled trial and seven observational studies met our inclusion criteria. Most observational studies suffered from different types of bias due to inappropriate selection of controls. Compilation of data from all included studies showed that ribavirin did not improve survival in CCHF (relative risk 1.06, 95% confidence interval 0.97-1.16). Analysis of secondary endpoints did not suggest a clinically significant beneficial effect either.
Our systematic review and meta-analysis revealed that the available data in the literature are inadequate to support a claim of efficacy of ribavirin in CCHF. We believe a real uncertainty exists over the benefit of ribavirin in the treatment of CCHF, which necessitates the urgent conduct of a randomized placebo-controlled trial.
克里米亚-刚果出血热（CCHF）是一种潜在致命的蜱传感染。该病毒在世界各地广泛分布，最近有零星病例和暴发的报告显著增加。一些作者提出利巴韦林可提高 CCHF 的生存率，这种观点似乎被广泛接受。
我们通过系统评价和荟萃分析来评估利巴韦林降低死亡率的疗效。我们纳入了比较使用利巴韦林治疗与未使用利巴韦林治疗的 CCHF 患者结局的随机对照试验和观察性研究。我们评估的主要终点是生存率。我们还评估了次要终点，即不良事件、住院时间、实验室值恢复正常的时间和血液制品的需求。使用随机效应模型获得来自每项研究的生存率相对风险的汇总估计值。
一项随机对照试验和七项观察性研究符合我们的纳入标准。由于对照选择不当，大多数观察性研究存在不同类型的偏倚。综合所有纳入研究的数据表明，利巴韦林并未改善 CCHF 的生存率（相对风险 1.06，95%置信区间 0.97-1.16）。对次要终点的分析也没有提示具有临床意义的有益效果。
我们的系统评价和荟萃分析表明，文献中的现有数据不足以支持利巴韦林在 CCHF 中的疗效主张。我们认为，利巴韦林在治疗 CCHF 中的益处存在真正的不确定性，这需要紧急进行随机安慰剂对照试验。
