Oseltamivir and Risk of Lower Respiratory Tract Complications in Patients With Flu Symptoms: A Meta-analysis of Eleven Randomized Clinical Trials

Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 06/2011; 53(3):277-9. DOI: 10.1093/cid/cir400
Source: PubMed


An independent reanalysis of 11 randomized clinical trials shows that oseltamivir treatment reduces the risk of lower respiratory tract complications requiring antibiotic treatment by 28% overall (95% confidence interval [CI], 11%-42%) and by 37% among patients with confirmed influenza infections (95% CI, 18%-52%).

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    • "older version of Turner et al . , replaced by Burch et al . [ 8 ] and Tappenden et al . [ 18 ] Heneghan CJ . Health Technology Assessment programme , 2011 , HTA - 32011001126 [ 58 ] only a protocol version , final version not available Hernán MA et al . Clin Infect Dis . 2011 [ 34 ] no systematic literature search , no critical quality appraisal for the included RCTs"
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    ABSTRACT: Controversy has arisen regarding the effectiveness of neuraminidase inhibitors (NIs), especially against influenza-related complications. A literature search was performed to critically assess the evidence collected by the available systematic reviews (SRs) regarding the benefits and disadvantages of NIs (oseltamivir, zanamivir) compared to placebos in healthy and at-risk individuals of all ages for prophylaxis and treatment of seasonal influenza. A SR was done using the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects, and Medline (January 2006-July 2012). Two reviewers selected SRs based on randomized clinical trials, which were restricted to intention-to-treat results, and they assessed review (AMSTAR) and study quality indicators (GRADE). The SRs included (N = 9) were of high quality. The efficacy of NIs in prophylaxis ranged from 64% (16-85) to 92% (37-99); the absolute risk reduction ranged from 1.2% to 12.1% (GRADE moderate to low). Clinically relevant treatment benefits of NIs were small in healthy adults and children suffering from influenza-like illness (GRADE high to moderate). Oseltamivir reduced antibiotic usage in healthy adults according to one SR, but this was not confirmed by other reviews (GRADE low). Zanamivir showed a preventive effect on antibiotic usage in children (95% (77-99);GRADE moderate) and on the occurrence of bronchitis in at-risk individuals (59% (30-76);GRADE moderate). No evidence was available on the treatment benefits of NIs in elderly and at-risk groups and their effects on hospitalization and mortality. In oseltamivir trials, nausea, vomiting and diarrhea were significant side-effects. For zanamivir trials, no adverse effects have been reported. The combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and financial cost outweigh the small benefits of oseltamivir or zanamivir for the prophylaxis and treatment of healthy individuals. No relevant benefits of these NIs on complications in at-risk individuals have been established.
    Full-text · Article · Apr 2013 · PLoS ONE
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    • "Treatment of influenza with neuraminidase inhibitor drugs should be initiated early in the course of disease (Coffin et al., 2011; Fiore et al., 2011; Heinonen et al., 2010; Hernan and Lipsitch, 2011; Kaiser et al., 2003; Treanor et al., 2000; Winther et al., 2010) but is underutilized (Fiore et al., 2011; Louie et al., 2012). Timely diagnosis of influenza is challenging (Hoeven et al., 2007; Talbot and Falsey, 2010), and confirmation of influenza infection by rapid influenza detection test can be helpful ( "
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    ABSTRACT: We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor(TM) System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor(TM) Flu A+B test showing the lowest limit of detection for all strains.
    Full-text · Article · Dec 2012 · Diagnostic microbiology and infectious disease
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    • "The 2009 influenza A (H1N1) pandemic provoked large-scale public health responses and implementation of pandemic preparedness plans throughout the world. Clinical trials have shown that neuraminidase inhibitors (NAIs), a class of antiviral drugs including oseltamivir and zanamivir, are efficacious in lowering morbidity related to influenza, reducing both the duration of symptoms from influenza and the overall severity of the illness [1], [2], [3], [4]. Furthermore, modeling studies suggest that treatment of symptomatic individuals with antivirals during a pandemic can reduce the overall disease attack rate and lessen the overall scope of local epidemics [5], [6], [7]. "
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    ABSTRACT: The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality. Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders. After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase). While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.
    Full-text · Article · Sep 2012 · PLoS ONE
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