The SARS virus set alarm bells ringing across the world when it first appeared in 2002, but now a review of the effectiveness of the treatments used against it has found no evidence that any of them worked. The review was commissioned by the World Health Organization and has been published in PLoS Medicine.
Severe acute respiratory syndrome (SARS) is caused by a virus; the main symptoms are pneumonia and fever. The virus is passed on when people sneeze or cough. In 2003 there were over 8,000 cases and 774 deaths worldwide. The situation was alarming, because the first ever cases only appeared in 2002, in China, and so the best way to treat this new disease was unknown.
Not many drugs are effective against viruses and all doctors can usually do with a viral disease is to treat symptoms like fever and inflammation, and rely on the body's own immune system to fight off the virus. However, in recent years a number of antiviral drugs have been developed (for example, there are several in use against HIV/AIDS) and there was hope that some of them might be active against SARS. Steroids have also been used in SARS treatment to try to reduce the inflammation of the lungs. To find out which, if any, of the potential treatments were effective, a number of research studies were carried out, both during and since the outbreak.
The World Health Organization (WHO) established an International SARS Treatment Study Group, which recommended that a 'systematic review' of potential SARS treatments should be carried out. In particular, it was considered important to bring together all the available evidence on the use of certain antiviral drugs (ribavirin, lopinavir and ritonavir), steroids, and proteins called immunoglobulins which are found naturally in human blood. The WHO group wanted to know how these treatments affected the virus outside the body ('in vitro') and whether it helped the condition of patients and reduced the death rate, especially in those patients who developed a dangerous complication called acute respiratory distress syndrome.
Researchers conducted a comprehensive search for information from research studies that fitted carefully pre-defined selection criteria. They found 54 SARS treatment studies, 15 in- vitro studies, and three acute respiratory distress syndrome studies. Some of the in-vitro studies with the antiviral drugs found that a particular drug reduced the reproduction rate of the viruses, but most of the studies of these drugs in patients were inconclusive. Of 29 studies on steroid use, 25 were inconclusive and four found that the treatment caused possible harm.
From the published studies, it is not possible to say whether any of the treatments used against SARS were effective. It is now many months since any new cases have been reported, but it is possible that the same or a similar virus might cause outbreaks in the future. It is disappointing that none of the research on SARS so far is likely to be useful in helping to decide on the best treatments to use in such an outbreak. The authors examined the weaknesses of the studies they found and urge that more effective methods of research should be applied in any future outbreaks. Their recommendations mean that researchers should be better prepared to learn from potential future outbreaks.
Citation: Stockman LJ, Bellamy R, Garner P (2006) SARS: Systematic review of treatment effects. PLoS Med 3(9): e343.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030343
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Surprising results from major Asian study
Diarrhoea remains one of the leading causes of death among children in developing countries. A major study in six countries has found that one microorganism that causes diarrhoea, Shigella, appears to be more common in the poorest communities of Asia than previously thought. Antibiotic-resistant strains were also found to have emerged. Based on their findings, the Korea-based researchers, writing in PLoS Medicine, call for more efforts to reduce the number of cases.
Citation: von Seidlein L, Kim DR, Ali M, Lee H, Wang XY, et al. (2006) A multicentre study of Shigella diarrhoea in six Asian countries: Disease burden, clinical manifestations, and microbiology. PLoS Med 3(9): e353.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030353
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Is DOTS plus a cost effective strategies for treating multidrug-resistant tuberculosis?
A research paper published this week in the international open access journal PLoS Medicine evaluated the feasibility, effectiveness, cost, and cost-effectiveness of a DOTS-Plus pilot project established at Makati Medical Center in Manila, the Philippines, in 1999. The authors, led by Katherine Floyd of the World Health Organisation, studied 117 patients and showed that in this setting the average cost to the health system was US$3,355, and US$837 to the patients. The authors calculated that the mean cost per disability-adjusted life year (DALY) gained by the DOTS-Plus project was US$242 (range US$85 to US$426). In a related perspective, Paul Garner and colleagues from the Liverpool School of Hygiene and Tropical Medicine assess the implications of these findings further, especially whether they can be extrapolated outside this specific setting.
Citation: Tupasi TE, Gupta R, Quelapio MID, Quelapio RB, Mira NR, et al. (2006) Feasibility and cost-effectiveness of treating multidrug-resistant tuberculosis: A cohort study in the Philippines. PLoS Med 3(9): e352.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030352
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A novel strategy for treatment of rheumatoid arthritis
A research paper published this week in the international open access journal PLoS Medicine describes a possible new experimental therapy for rheumatoid arthritis and other autoimmune inflammatory diseases. The researchers, led by Rikard Holmdahl from Lund University, exploits a new finding in a mouse model that lack of reactive oxygen species makes arthritis worse rather than, as had been expected, better in a mouse model with arthritis. Reactive oxygen species are thought to be important in defense against pathogens. The researcher tested phytol, which increased oxidative burst in vivo, and found that it improved the arthritis in the mouse model with arthritis. In testing, also in mice, phytol showed comparative effectiveness to standard therapies for arthritis such as anti-tumour necrosis factor-á and methotrexate. The authors conclude that these results "suggest a novel pathway of autoimmune inflammatory disease and possibly a novel therapeutic strategy." A Perspective article by Andrew Cope, from Imperial College London, discusses the study's findings further.
Citation: Hultqvist M, Olofsson P, Gelderman KA, Holmberg J, Holmdahl R (2006) A new arthritis therapy with oxidative burst inducers. PLoS Med 3(9): e348.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.doi.org/10.1371/journal.pmed.0030348
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PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
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