Preliminary Report Suggests Combination Therapy May Help Treat SARS

According to background information in the article, SARS is characterized by fever, lower respiratory tract symptoms, and abnormal findings on chest x-ray. As of September 26, 2003, the World Health Organization has recorded 8,098 SARS cases and 774 SARS-related deaths from 27 countries. Treatment for SARS has included antibiotic therapy, corticosteroids and other drug therapies, but there is little compelling evidence that these strategies improve outcome. A group of drugs called interferons inhibit viral infections by boosting the body's immune response. In laboratory experiments, interferons were effective in inhibiting a strain of a SARS-related virus.

Mona R. Loutfy, M.D., M.P.H., of the North York General Hospital, Toronto, Ontario, and colleagues conducted a study between April 11 and May 30, 2003, to assess the use of corticosteroids vs. corticosteroids plus subcutaneous interferon alfacon-1 in 22 patients diagnosed as having probable SARS.

Thirteen patients were treated with corticosteroids alone and nine patients were treated with corticosteroids plus interferon alfacon-1. The patients included 16 women and 6 men ranging in age from 16 to 86 years.

The researchers found that the resolution of fever was similar between the two treatment groups. Of the 13 patients treated with corticosteroids alone, 5 (38.5 percent) were transferred to the intensive care unit, 3 (23.1 percent) required intubation and mechanical ventilation, and 1 (7.7 percent) died. Of the nine patients in the interferon alfacon-1 treatment group, 3 (33.3 percent) were transferred to the intensive care unit, 1 (11.1 percent) required intubation and mechanical ventilation, and none died.

The researchers also found that the interferon alfacon-1 group experienced a shorter time to resolution of chest x-ray abnormalities, and required supplemental oxygen for a shorter period of time.

"These preliminary findings suggest that treatment with interferon alfacon-1 and steroids was associated with more rapid resolution of radiographic lung abnormalities and better oxygen saturation levels than treatment with corticosteroids alone," write the authors.

"These findings suggest that further investigation may be warranted to determine the role of interferon alfacon-1 as a therapeutic agent for the treatment of SARS," conclude the researchers.

(JAMA. 2003;290:3222-3228. Available post-embargo at http://jama.com)

Editor's Note: This work was funded by a grant from the Canadian Institutes of Health Research (CIHR) and Ontario Research and Development Challenge Fund (ORDCF) to Drs. Siminovitch, Dennis and Fish. Intermune Corp. provided the interferon alfacon-1 at no cost. Dr. Kain holds a Canada Research Chair, Dr. Loutfy is a CIHR postdoctoral fellow (McGill University, Montreal, Quebec), and Dr. Siminovitch is a CIHR senior scientist.