Pharmacologic treatment of SARS: current knowledge and recommendations

Area of Science:

• Infectious Diseases
• Virology
• Clinical Medicine

Background:

• The 2003 Severe Acute Respiratory Syndrome (SARS) pandemic emerged rapidly, precluding randomized controlled trials.
• Understanding of SARS treatment relied on observational data, case series, and reports.
• Early treatment strategies were based on limited initial observations.

Purpose of the Study:

• To review and synthesize available information on SARS treatment modalities.
• To provide clinical management guidelines based on observational evidence.
• To inform future research directions for potential SARS recurrence.

Main Methods:

• Review of observational studies, cohort studies, case series, and case reports.
• Analysis of treatment outcomes associated with ribavirin, corticosteroids, and other agents.
• Evaluation of the efficacy and toxicity of various therapeutic interventions.

Main Results:

• Ribavirin showed high toxicity and lacked in vitro efficacy against SARS-coronavirus (SAR-CoV).
• Corticosteroid use, particularly pulse methylprednisolone, showed potential in critical SARS cases but carries risks.
• Kaletra (ritonavir/lopinavir) may be considered for early treatment, ideally in controlled trials.
• Interferon (IFN) is not recommended for standard therapy but warrants controlled trials if SARS recurs.
• Experimental treatments lack sufficient evidence for recommendation.

Conclusions:

• Evidence from observational data is crucial for managing SARS and guiding future research.
• Current understanding suggests caution with ribavirin and highlights the controversial role of corticosteroids.
• Further controlled trials are needed for agents like Kaletra and Interferon in case of SARS re-emergence.