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.