tetano
Editor, Senior Moderator
Eur Respir J
. 2020 Jun 11;1902246.
doi: 10.1183/13993003.02246-2019. Online ahead of print.
Oseltamivir and Influenza-Related Complications in Children: A Retrospective Cohort in Primary Care
Joseph Jonathan Lee[SUP] 1 [/SUP], Margaret Smith[SUP] 2 3 [/SUP], Clare Bankhead[SUP] 2 3 [/SUP], Rafael Perera Salazar[SUP] 2 3 [/SUP], Antonis A Kousoulis[SUP] 4 [/SUP], Christopher C Butler[SUP] 2 [/SUP], Kay Wang[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Influenza and influenza-like illness (ILI) place considerable burden on health care systems, especially during influenza epidemics and pandemics. During the 2009/10 H1N1 influenza pandemic, UK national guidelines recommended antiviral medications for patients presenting within 72 h of ILI onset. However, it is not clear whether antiviral treatment was associated with reductions in influenza-related complications.
Methods: Our study population consisted of a retrospective cohort of children aged 17 years or younger who presented with influenza/ILI at UK primary care practices contributing to the Clinical Practice Research Datalink during the 2009/10 pandemic. We used doubly robust inverse-probability weighted propensity scores and physician prior prescribing instrumental variable methods to estimate the causal effect of oseltamivir prescribing on influenza-related complications. Secondary outcomes were complications requiring intervention, pneumonia, pneumonia or hospitalisation, influenza-related hospitalisation and all-cause hospitalisation.
Results: We included 16 162 children of whom 4028 (24.9%) were prescribed oseltamivir, and 753 (4.7%) had recorded complications. Under propensity score analyses oseltamivir prescriptions were associated with reduced influenza-related complications (Risk Difference -0.015, 95% confidence interval [CI] -0.022 to -0.008), complications requiring further intervention, pneumonia, pneumonia or hospitalisation and influenza-related hospitalisation, but not all-cause hospitalisation. Adjusted instrumental variable analyses estimated reduced influenza-related complications (RD -0.032, 95%CI -0.051 to -0.013), pneumonia or hospitalisation, all cause and influenza-related hospitalisations.
Conclusions: Based on causal inference analyses of observational data, oseltamivir treatment in children with influenza/ILI was associated with a small but statistically significant reduction in influenza-related complications during an influenza pandemic.
. 2020 Jun 11;1902246.
doi: 10.1183/13993003.02246-2019. Online ahead of print.
Oseltamivir and Influenza-Related Complications in Children: A Retrospective Cohort in Primary Care
Joseph Jonathan Lee[SUP] 1 [/SUP], Margaret Smith[SUP] 2 3 [/SUP], Clare Bankhead[SUP] 2 3 [/SUP], Rafael Perera Salazar[SUP] 2 3 [/SUP], Antonis A Kousoulis[SUP] 4 [/SUP], Christopher C Butler[SUP] 2 [/SUP], Kay Wang[SUP] 2 [/SUP]
Affiliations
- PMID: 32527739
- DOI: 10.1183/13993003.02246-2019
Abstract
Background: Influenza and influenza-like illness (ILI) place considerable burden on health care systems, especially during influenza epidemics and pandemics. During the 2009/10 H1N1 influenza pandemic, UK national guidelines recommended antiviral medications for patients presenting within 72 h of ILI onset. However, it is not clear whether antiviral treatment was associated with reductions in influenza-related complications.
Methods: Our study population consisted of a retrospective cohort of children aged 17 years or younger who presented with influenza/ILI at UK primary care practices contributing to the Clinical Practice Research Datalink during the 2009/10 pandemic. We used doubly robust inverse-probability weighted propensity scores and physician prior prescribing instrumental variable methods to estimate the causal effect of oseltamivir prescribing on influenza-related complications. Secondary outcomes were complications requiring intervention, pneumonia, pneumonia or hospitalisation, influenza-related hospitalisation and all-cause hospitalisation.
Results: We included 16 162 children of whom 4028 (24.9%) were prescribed oseltamivir, and 753 (4.7%) had recorded complications. Under propensity score analyses oseltamivir prescriptions were associated with reduced influenza-related complications (Risk Difference -0.015, 95% confidence interval [CI] -0.022 to -0.008), complications requiring further intervention, pneumonia, pneumonia or hospitalisation and influenza-related hospitalisation, but not all-cause hospitalisation. Adjusted instrumental variable analyses estimated reduced influenza-related complications (RD -0.032, 95%CI -0.051 to -0.013), pneumonia or hospitalisation, all cause and influenza-related hospitalisations.
Conclusions: Based on causal inference analyses of observational data, oseltamivir treatment in children with influenza/ILI was associated with a small but statistically significant reduction in influenza-related complications during an influenza pandemic.