Comparative effectiveness of aerosolized versus oral ribavirin for the treatment of respiratory syncytial virus infections: A single-center retrospective cohort study and review of the literature.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of viral infections in immunocompromised hosts and is associated with significant morbidity and mortality. In January 2015, our institution switched from aerosolized to oral ribavirin (RBV) for primary treatment of RSV infection among high-risk immunocompromised adult patients. The objective of the study was to evaluate the clinical and economic outcomes associated with this switch.

METHODS: Retrospective cohort analysis of adult patients diagnosed with RSV infection and treated with RBV between January 1, 2013, and May 31, 2016.

RESULTS: Of 46 patients, 20 (43%) patients received oral RBV and 26 (57%) received aerosolized RBV. Underlying conditions included lung transplant (n = 22), hematopoietic cell transplant (n = 16), hematological malignancy (n = 5), and structural lung diseases (n = 4). At the time of RSV diagnosis, 42 (91%) were hospitalized, 36 (78%) had clinical and radiographic evidence of lower respiratory tract infection (RTI), 9 (20%) were admitted to the ICU, and 4 (9%) required intubation. There were no differences in clinical outcomes between the 2 groups with regard to adverse events, progression from upper to lower RTI, escalation of care, or 30-day mortality. Three (15%) in the oral group and 1 (4%) in the aerosolized group died within 30 days (P = .33). The cost avoidance attributable to the switch in therapy over 1 year is $1.2 million.

CONCLUSION: Oral RBV appears to be a safe and cost-effective alternative to aerosolized RBV for the management of RSV infection in immunocompromised patients. Larger studies are needed to validate the safety and efficacy of this approach.