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A Preliminary Study

Mona R. Loutfy, MD, MPH; Lawrence M. Blatt, PhD; Katharine A. Siminovitch, MD; Sarah Ward, BSc; Bryan Wolff, MD; Hyoung Lho, MD; Dieu H. Pham, MD; Hassan Deif, MD; Elizabeth A. LaMere, MD; Margaret Chang, MD; Kevin C. Kain, MD; Gabriella A. Farcas, BSc; Patti Ferguson, BScPhm; Mary Latchford, BSc, MLT; Gary Levy, MD; James W. Dennis, PhD; Enoch K. Y. Lai, MD; Eleanor N. Fish, PhD

JAMA. 2003;290:3222-3228.

Context  Severe acute respiratory syndrome (SARS) is a new clinical entity for which no effective therapeutic strategy has been developed.

Objective  To provide preliminary results on the potential therapeutic benefit and tolerability of interferon alfacon-1 plus corticosteroids for SARS.

Design, Setting, and Patients  Open-label study of 22 patients diagnosed as having probable SARS at North York General Hospital, Toronto, Ontario, between April 11 and May 30, 2003.

Interventions  Thirteen patients were treated with corticosteroids alone and 9 patients were treated with corticosteroids plus subcutaneous interferon alfacon-1.

Main Outcome Measures  Clinical parameters, including oxygen saturation and requirement, laboratory measures, and serial chest radiography results.

Results  Resolution of fever and lymphopenia were similar between the 2 treatment groups. Of the 13 patients treated with corticosteroids alone, 5 (38.5%) were transferred to the intensive care unit, 3 (23.1%) required intubation and mechanical ventilation, and 1 (7.7%) died. Of the 9 patients in the interferon alfacon-1 treatment group, 3 (33.3%) were transferred to the intensive care unit, 1 (11.1%) required intubation and mechanical ventilation, and none died. The interferon alfacon-1 treatment group had a shorter time to 50% resolution of lung radiographic abnormalities (median time, 4 days vs 9 days; P = .001), had better oxygen saturation (P = .02), resolved their need for supplemental oxygen more rapidly (median, 10 days vs 16 days; P = .02), had less of an increase in creatine kinase levels (P = .03), and showed a trend toward more rapid resolution of lactate dehydrogenase levels compared with the group receiving corticosteroids alone.

Conclusions  In this preliminary, uncontrolled study of patients with SARS, use of interferon alfacon-1 plus corticosteroids was associated with reduced disease-associated impaired oxygen saturation, more rapid resolution of radiographic lung abnormalities, and lower levels of creatine kinase. 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.

Author Affiliations: North York General Hospital (Drs Loutfy, Wolff, Lho, Pham, Deif, LaMere, Chang, and Lai and Mss Ferguson and Latchford), Toronto General Research Institute and University of Toronto (Drs Siminovitch, Kain, Levy, and Fish and Mss Ward and Farcas), and Mt Sinai Hospital and University of Toronto (Dr Dennis), Toronto, Ontario; and Intermune Corp, Brisbane, Calif (Dr Blatt).

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