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Interferon-β-1a for patients with moderate to severe acute respiratory distress syndrome: a systematic review and meta-analysis of randomized trials.

INTRODUCTION
Acute respiratory distress syndrome (ARDS) is a life-threatening disease characterized by respiratory failure with rapidly progressing inflammation. No effective pharmacological treatment currently exists for ARDS.


OBJECTIVES
We conducted this systematic review and meta-analysis to examine interferon-β-1a (IFNβ) treatment in ARDS.


METHODS
Data sources included MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. We retained trials from 1996 to February 25th, 2020 that comparatively examined the use of IFNβ in patients with ARDS. Two reviewers identified eligible studies, independently extracted study data, and assessed risk of bias. Authors assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.


RESULTS
We included two trials (n=392 patients). Use of IFNβ had no significant difference on 28-day hospital mortality (risk ratio [RR] 0.59, 95% CI: 0.13 to 2.67, p=0.49, very low certainty) or on ventilator-free days (VFD) (MD 4.85 days, 95% CI: -3.25 days to 12.93 days, p=0.24, very low certainty), compared to no IFNβ. IFNβ also had no significant impact on the risk of adverse events (RR 0.98%, 95% CI: 0.94 to 1.03, p=0.47, low certainty).


CONCLUSIONS
The use of IFNβ does not appear to improve mortality, VFD or adverse events in ARDS patients. This review is based on two small studies with limited numbers of events, which raises uncertainties in IFNβ true effects. The analysis of one study reveals increased mortality with the concomitant use of corticosteroids and IFNβ, suggesting careful consideration of drug-drug interactions with this combination.