Journal
EMERGING INFECTIOUS DISEASES
Volume 28, Issue 8, Pages 1559-1568Publisher
CENTERS DISEASE CONTROL & PREVENTION
DOI: 10.3201/eid2808.211787
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Funding
- World Health Organization [2019/890244-1]
- NIHR Doctoral Research Fellowship [DRF-2018-11ST2-048]
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol
- UK Health Security Agency
- NIHR Applied Research Collaboration West
- Department of Health and Social Care
- London School of Hygiene & Tropical Medicine
- Wellcome Trust [215091/Z/18/Z]
- Bill and Melinda Gates Foundation [OPP1209135]
- EDCTP2 Programme - European Union [ALERRT: RIA2016E1612]
- NIHR Bristol Biomedical Research Centre
- Health Data Research UK South West
- Bill and Melinda Gates Foundation [OPP1209135] Funding Source: Bill and Melinda Gates Foundation
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This study systematically reviewed the effectiveness of ribavirin for treating Lassa fever and found a lack of robust evidence supporting its use. The existing studies had significant biases and more high-quality clinical trials are needed to elucidate the effectiveness of ribavirin.
Ribavirin has been used widely to treat Lassa fever in West Africa since the 1980s. However, few studies have systematically appraised the evidence for its use. We conducted a systematic review of published and unpublished literature retrieved from electronic databases and gray literature from inception to March 8, 2022. We identified 13 studies of the comparative effectiveness of ribavirin versus no ribavirin treatment on mortality outcomes, including unpublished data from a study in Sierra Leone provided through a US Freedom of Information Act request. Although ribavirin was associated with decreased mortality rates, results of these studies were at critical or serious risk for bias when appraised using the ROBINS-I tool. Important risks for bias related to lack of control for confounders, immortal time bias, and missing outcome data. Robust evidence supporting the use of ribavirin in Lassa fever is lacking. Well-conducted clinical trials to elucidate the effectiveness of ribavirin for Lassa fever are needed.
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