Ribavirin for treating Crimean Congo haemorrhagic fever

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Samuel Johnson 1,Nicholas Henschke 2,Nicola Maayan 2, Inga Mills 2,Brian S Buckley 3, Artemisia Kakourou 4,Rachel Marshall 2

1. Samuel Johnson, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
2. Cochrane, Cochrane Response, London, UK
3. University of Philippines, Department of Surgery, Manila, Philippines
4. University of Ioannina School of Medicine, Department of Hygiene and Epidemiology, Ioannina, Greece

Johnson SHenschke NMaayan NMills IBuckley BSKakourou AMarshall RRibavirin for treating Crimean Congo haemorrhagic feverCochrane Database of Systematic Reviews 2018, Issue 6. Art. No.: CD012713. DOI: 10.1002/14651858.CD012713.pub2.

Access the full text article here: DOI: 10.1002/14651858.CD012713.pub2/full

What is the aim of this review?

The aim of this Cochrane review is to find out if ribavirin is an effective treatment for Crimean Congo haemorrhagic fever. Cochrane researchers collected and analysed all relevant studies to answer this question. We found 23 studies. We include five studies in this review that helped answer the question. We analysed the other 18 studies to help describe the limitations of the evidence.

Key messages

There is insufficient reliable evidence to show whether ribavirin is effective in treating Crimean Congo haemorrhagic fever. A randomised clinical trial could help answer this question.

What was studied in the review?

Crimean Congo haemorrhagic fever (CCHF) is an infection spread by tick bites. It has become more common in the last 15 years, particularly in Turkey and parts of Eastern Europe. CCHF can be life threatening. The most important way of caring for people who are seriously unwell with CCHF is to monitor them closely in hospital and give them any fluid or blood products they may need.

Ribavirin is an antiviral drug that some doctors use to treat CCHF. It is widely available and is normally taken by mouth. There is debate over whether ribavirin is needed to treat CCHF; some argue that it is an effective treatment, or helps if given early, whilst others say that it has no effect, in terms of the risk of death, the length of time needed in hospital, and the extent of harm from the drug itself.

Overall, the study designs did not take into account factors other than taking ribavirin that could result in better outcomes in the intervention group, including how ill the patient was when diagnosed, or when good supportive medical care was started. This made any association between ribavirin and lower mortality problematic.

We found five studies that took into account important factors that could confound the risk of dying with whether or not a patient received ribavirin. These include how sick the study participants were, what other care they received, and how long after they became sick they received medical care. All included studies were conducted in Turkey and Iran, and compared people with CCHF who received ribavirin and supportive care to those who received supportive care alone. We looked at five different outcomes relating to ribavirin use in CCHF, and found that there is insufficient reliable evidence to determine whether ribavirin is effective.

How up to date is the review?

The review authors searched for studies that had been published up to 16 October 2017.