Effectiveness of ribavirin and corticosteroids for severe acute respiratory syndrome

Am J Med. 2009 Dec;122(12):1150.e11-21. doi: 10.1016/j.amjmed.2009.07.018.


Objective: Ribavirin and corticosteroids were used widely as front-line treatments for severe acute respiratory syndrome; however, previous evaluations were inconclusive. We assessed the effectiveness of ribavirin and corticosteroids as the initial treatment for severe acute respiratory syndrome using propensity score analysis.

Methods: We analyzed data on 1755 patients in Hong Kong and 191 patients in Toronto with severe acute respiratory syndrome using a generalized propensity score approach.

Results: The adjusted excess case fatality ratios of patients with severe acute respiratory syndrome receiving the combined therapy of ribavirin and corticosteroids within 2 days of admission, compared with those receiving neither treatment within 2 days of admission, were 3.8% (95% confidence interval, -1.5 to 9.2) in Hong Kong and 2.1% (95% confidence interval, -44.3 to 48.5) in Toronto.

Conclusions: Our results add strength to the hypothesis that the combination of ribavirin and corticosteroids has no therapeutic benefit when given early during severe acute respiratory syndrome infection. Further studies may investigate the effects of these treatments later in disease course.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use*
  • Canada / epidemiology
  • Cohort Studies
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Hong Kong / epidemiology
  • Hospitalization
  • Humans
  • L-Lactate Dehydrogenase
  • Middle Aged
  • Propensity Score
  • Respiratory Distress Syndrome, Adult / drug therapy*
  • Respiratory Distress Syndrome, Adult / mortality*
  • Retrospective Studies
  • Ribavirin / therapeutic use*
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Antiviral Agents
  • Ribavirin
  • L-Lactate Dehydrogenase