Early data highlight ribavirin’s anti-adenovirus potential

Preliminary data suggest that the guanosine analogue ribavirin may be beneficial in immunocompromised children with severe adenoviral disease. Ribavirin therapy brought about complete recovery in two of five children, prompting calls for a large, multicentre clinical trial to determine the efficacy and safety of this strategy.

Severe paediatric adenovirus disease is increasing in association with a rise in immunocompromised children, where case fatality rates can be as high as 50–80%. Ribavirin has broad antiviral activity against both RNA and DNA viruses, as well as documented activity against adenoviruses in vitro.

Writing in the journal Pediatrics, Patrick Gavin and Ben Katz from the Children’s Memorial Hospital and Northwestern University Medical School, Chicago, review outcomes from five paediatric adenovirus cases, as well as their findings from a literature review.

Five immunocompromised children with severe adenovirus disease were treated with intravenous ribavirin, following an FDA-approved ‘compassionate use’ protocol.

Two children experienced complete clinical recovery with subsequent viral clearance; one had undergone cardiac transplantation and developed adenovirus haemorrhagic cystitis and the other was an immunocompetent neonate with adenovirus pneumonia, Gavin and Katz report. The remaining three children died of adenovirus disease.

The authors comment: “Our series of patients is representative of the spectrum of immunocompromised children at greatest risk for severe adenovirus disease, namely solid-organ and bone marrow transplant recipients, neonates, and children with immunodeficiency.

“Given the seriousness and increasing prevalence of adenovirus disease in certain hosts, especially children, a large, multicentre clinical trial of potentially useful anti-adenoviral therapies, such as intravenous ribavirin, is clearly required to demonstrate the most effective and least toxic therapy.”