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PLoS ONE. Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09
Janice K. Louie<SUP>1</SUP><SUP>*</SUP>, Samuel Yang<SUP>1</SUP>, Cynthia Yen<SUP>1</SUP>, Meileen Acosta<SUP>1</SUP>, Robert Schechter<SUP>1</SUP>, Timothy M. Uyeki<SUP>2</SUP>
1 California Department of Public Health, Richmond, California, United States of America, 2 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety.
Citation: Louie JK, Yang S, Yen C, Acosta M, Schechter R, et al. (2012) Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09. PLoS ONE 7(6): e40261. doi:10.1371/journal.pone.0040261
Editor: Steven J. Drews, University of Calgary & ProvLab Alberta, Canada
Received: January 20, 2012; Accepted: June 4, 2012; Published: June 29, 2012
Copyright: ? 2012 Louie et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: No current external funding sources for this study.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: Janice.louie@cdph.ca.gov
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Janice K. Louie<SUP>1</SUP><SUP>*</SUP>, Samuel Yang<SUP>1</SUP>, Cynthia Yen<SUP>1</SUP>, Meileen Acosta<SUP>1</SUP>, Robert Schechter<SUP>1</SUP>, Timothy M. Uyeki<SUP>2</SUP>
1 California Department of Public Health, Richmond, California, United States of America, 2 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety.
Citation: Louie JK, Yang S, Yen C, Acosta M, Schechter R, et al. (2012) Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09. PLoS ONE 7(6): e40261. doi:10.1371/journal.pone.0040261
Editor: Steven J. Drews, University of Calgary & ProvLab Alberta, Canada
Received: January 20, 2012; Accepted: June 4, 2012; Published: June 29, 2012
Copyright: ? 2012 Louie et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: No current external funding sources for this study.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: Janice.louie@cdph.ca.gov