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BMJ: Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial

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  • BMJ: Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial

    BMJ Open. 2017 Jul 10;7(7):e014546. doi: 10.1136/bmjopen-2016-014546.
    Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial.

    Flicoteaux R1,2, Protopopescu C3,4, Tibi A5, Blanchon T6, Werf SV7, Duval X1, Mosnier A8, Charlois-Ou C1, Lina B9,10, Leport C1, Chevret S2.
    Author information

    Abstract

    OBJECTIVES:

    We aimed to evaluate and compare non-adherence to oral and inhaled antiviral therapies prescribed of a randomised clinical trial in outpatients with influenza A infection.
    DESIGN:

    A parallel, three-arm, double-blinded trial randomly allocated antiviral therapies twice daily for 5 days: (1) oral oseltamivir plus inhaled zanamivir (arm OZ); (2) oseltamivir plus inhaled placebo (arm Opz); or (3) oral placebo plus inhaled zanamivir (arm poZ). Analysis of non-adherence was a secondary objective of the trial.
    SETTINGS:

    Outpatients were enrolled by 145 general practitioners throughout France during the 2008-2009 seasonal influenza epidemics.
    PARTICIPANTS:

    A total of 541 adults presenting with influenza-like illness for less than 36 hours.
    PRIMARY OUTCOMES:

    Non-persistence, the time between inclusion and the last dose treated as a failure time, was used as the primary endpoint.
    RESULTS:

    The proportions of patients who persisted on treatment until the end of prescription were estimated at 85.73% (3.28%) for the oral route and 82.73% (3.44%) for the inhaled route. Based on multivariable models, non-persistence was associated with a PCR confirmation of influenza for both the oral (HR=0.54, p=0.010) and inhaled (HR=0.59, p=0.018) drugs and antibiotic coprescriptions (HR=2.07, p=0.007; and HR=1.88, p=0.017, respectively) and active combination treatment (HR=1.71, p=0.035; and HR=1.58, p=0.035, respectively). The hazard of non-persistence of the inhaled therapy was increased compared with that of the oral therapy (HR=1.23, p=0.043).
    CONCLUSION:

    In addition to the clinical and virological profiles of influenza infection, non-persistence may have been influenced by an active combination and the route of administration.
    RCT REGISTRATION NUMBER:

    NCT00799760. This is a post-result analysis.
    Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


    KEYWORDS:

    Antiviral Agents; Controlled Clinical Trials; Human Influenza; Medication Non-Adherence; Randomized

    PMID: 28698321 DOI: 10.1136/bmjopen-2016-014546
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