tetano
Editor, Senior Moderator
J Infect Dis. 2019 Dec 11. pii: jiz656. doi: 10.1093/infdis/jiz656. [Epub ahead of print] [h=1]Comparative effectiveness of combined favipiravir and oseltamivir therapy versus oseltamivir monotherapy in critically ill patients with influenza virus infection.[/h]
Wang Y[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Fan G[SUP]1,[/SUP][SUP]2,[/SUP][SUP]4[/SUP], Salam A[SUP]5[/SUP], Horby P[SUP]5[/SUP], Hayden FG[SUP]6[/SUP], Chen C[SUP]7[/SUP], Pan J[SUP]8[/SUP], Zheng J[SUP]9[/SUP], Lu B[SUP]1,[/SUP][SUP]2[/SUP], Guo L[SUP]1[/SUP], Wang C[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Cao B[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP]; CAP-China Network.
[h=3]Author information[/h] 1 Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. 2 Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. 3 Department of Respiratory Medicine, Capital Medical University, Beijing, China. 4 Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China. 5 Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. 6 Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA. 7 Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Soochow University, Jiangsu Province, China. 8 Department of Pulmonary and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Fujian Province, China. 9 The Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] A synergistic effect of combination therapy with favipiravir and oseltamivir has been reported in pre-clinical models of influenza. However, no data are available on the clinical effectiveness of combination therapy in severe influenza.
[h=4]METHODS:[/h] Data from two separate prospective studies of influenza adults were used to compare outcomes between combination and oseltamivir monotherapy. Outcomes includes rate of clinical improvement, defined as a decrease of 2 categories on a 7-category ordinal scale, and viral RNA detectability over time. Sub-hazard ratio (sHR) was estimated by Fine and Gray model for competing risks.
[h=4]RESULTS:[/h] In total, 40 patients were treated with combination therapy and 128 with oseltamivir alone. Clinical improvement on Day 14 occurred in the combination group was higher than in monotherapy group (62.5% vs 42.2%, p=0.0247). The adjusted sHR for combination therapy was 2.06 (95%CI: 1.3-3.26). The proportion of undetectable viral RNA at day 10 was higher in the combination group than oseltamivir group (67.5% vs 21.9%, p<0.01). No significant differences were observed in mortality or other outcomes.
[h=4]CONCLUSIONS:[/h] Favipiravir and oseltamivir combination therapy may accelerate clinical recovery compared to oseltamivir monotherapy in severe influenza, and this strategy should be formally evaluated in a randomized controlled trial.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] critical ill; favipiravir; influenza; oseltamivir; outcome
PMID: 31822885 DOI: 10.1093/infdis/jiz656
Wang Y[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Fan G[SUP]1,[/SUP][SUP]2,[/SUP][SUP]4[/SUP], Salam A[SUP]5[/SUP], Horby P[SUP]5[/SUP], Hayden FG[SUP]6[/SUP], Chen C[SUP]7[/SUP], Pan J[SUP]8[/SUP], Zheng J[SUP]9[/SUP], Lu B[SUP]1,[/SUP][SUP]2[/SUP], Guo L[SUP]1[/SUP], Wang C[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP], Cao B[SUP]1,[/SUP][SUP]2,[/SUP][SUP]3[/SUP]; CAP-China Network.
[h=3]Author information[/h] 1 Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. 2 Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. 3 Department of Respiratory Medicine, Capital Medical University, Beijing, China. 4 Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China. 5 Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. 6 Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA. 7 Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Soochow University, Jiangsu Province, China. 8 Department of Pulmonary and Critical Care Medicine, Fuzhou Pulmonary Hospital of Fujian, Fujian Province, China. 9 The Fifth Medical Centre, Chinese PLA General Hospital, Beijing, China.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] A synergistic effect of combination therapy with favipiravir and oseltamivir has been reported in pre-clinical models of influenza. However, no data are available on the clinical effectiveness of combination therapy in severe influenza.
[h=4]METHODS:[/h] Data from two separate prospective studies of influenza adults were used to compare outcomes between combination and oseltamivir monotherapy. Outcomes includes rate of clinical improvement, defined as a decrease of 2 categories on a 7-category ordinal scale, and viral RNA detectability over time. Sub-hazard ratio (sHR) was estimated by Fine and Gray model for competing risks.
[h=4]RESULTS:[/h] In total, 40 patients were treated with combination therapy and 128 with oseltamivir alone. Clinical improvement on Day 14 occurred in the combination group was higher than in monotherapy group (62.5% vs 42.2%, p=0.0247). The adjusted sHR for combination therapy was 2.06 (95%CI: 1.3-3.26). The proportion of undetectable viral RNA at day 10 was higher in the combination group than oseltamivir group (67.5% vs 21.9%, p<0.01). No significant differences were observed in mortality or other outcomes.
[h=4]CONCLUSIONS:[/h] Favipiravir and oseltamivir combination therapy may accelerate clinical recovery compared to oseltamivir monotherapy in severe influenza, and this strategy should be formally evaluated in a randomized controlled trial.
? The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] critical ill; favipiravir; influenza; oseltamivir; outcome
PMID: 31822885 DOI: 10.1093/infdis/jiz656