Ribavirin has been used widely to treat Lassa fever in West Africa since the 1980s. However, few studies have systematically appraised the evidence for its use. We conducted a systematic review of published and unpublished literature retrieved from electronic databases and gray literature from inception to March 8, 2022. We identified 13 studies of the comparative effectiveness of ribavirin versus no ribavirin treatment on mortality outcomes, including unpublished data from a study in Sierra Leone provided through a US Freedom of Information Act request. Although ribavirin was associated with decreased mortality rates, results of these studies were at critical or serious risk for bias when appraised using the ROBINS-I tool. Important risks for bias related to lack of control for confounders, immortal time bias, and missing outcome data. Robust evidence supporting the use of ribavirin in Lassa fever is lacking. Well-conducted clinical trials to elucidate the effectiveness of ribavirin for Lassa fever are needed.

中文翻译：

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在已发表和未发表研究的系统评价中缺乏利巴韦林治疗拉沙热的证据1。

自 20 世纪 80 年代以来，利巴韦林在西非广泛用于治疗拉沙热。然而，很少有研究系统地评估其使用的证据。我们对从成立到 2022 年 3 月 8 日的电子数据库和灰色文献中检索到的已发表和未发表的文献进行了系统回顾。我们确定了 13 项关于利巴韦林与不使用利巴韦林治疗对死亡率结果的比较有效性的研究，包括来自一项研究的未发表数据塞拉利昂通过美国信息自由法请求提供。尽管利巴韦林与死亡率降低相关，但当使用 ROBINS-I 工具进行评估时，这些研究的结果存在严重或严重的偏倚风险。偏差的重要风险与缺乏对混杂因素的控制、不朽的时间偏差和缺失结果数据有关。缺乏支持利巴韦林治疗拉沙热的有力证据。需要进行良好的临床试验来阐明利巴韦林对拉沙热的有效性。