Ribavirin Aerosol in the Treatment of SARS-CoV-2

Ribavirin is an inosine monophosphate dehydrogenase inhibitor with demonstrated activity against coronaviruses, including SARS-CoV-2. Two hospitalized patients with COVID-19 (confirmed by positive tests for SARS-CoV-2) received treatment with ribavirin for inhalation solution (ribavirin aerosol) as part of a compassionate use program. Patient 1 was a 33-year-old male with an unremarkable medical history. Patient 2 was a 29-year-old male who was an active smoker. Both patients were managed according to international and Italian treatment guidelines for COVID-19. In addition, therapy with ribavirin aerosol 100 mg/mL was administered for 30 minutes twice daily for 6 days (ie, 12 doses) in both patients. In order to address concerns about a possible increase in viral dispersal with the use of a nebulizer, healthcare providers remained outside the patient room during ribavirin aerosol administration. Pretreatment chest computed tomography scans showed pseudonodular areas in the upper right lobe with associated ground glass opacities (Patient 1) and multiple areas of parenchymal consolidation in both lower lobes with associated ground glass opacities (Patient 2) that were almost completely resolved on imaging at the end of ribavirin treatment. No adverse reactions to ribavirin treatment were observed in either patient. Both patients recovered fully, and 2 sequential nasopharyngeal swabs obtained after hospital discharge tested negative for SARS-CoV-2. Ribavirin aerosol appears to be efficacious in the treatment of patients with COVID-19. The compassionate use study of ribavirin aerosol is ongoing and will provide additional data across a broader patient population.