Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-10 influenza A(H1N1) pandemic: a systematic review

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J Infect Dis. (2012) doi: 10.1093/infdis/jis726

Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-10 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients

Stella G. Muthuri*,1,
Puja R. Myles*,1,
Sudhir Venkatesan1,
Jo Leonardi-Bee2 and
Jonathan S. Nguyen-Van-Tam1

+ Author Affiliations

1Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, UK
2Division of Epidemiology and Public Health, University of Nottingham, UK

Correspondence: Jonathan Van-Tam, DM, FFPH, Room A40d, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, United Kingdom (jvt@nottingham.ac.uk).

↵* Dr Muthuri and Dr Myles wish to be named as Joint First Authors

Abstract

Background. The impact of neuraminidase inhibitors (NAI) treatment on clinical outcomes of public health importance during the 2009-10 pandemic has not been firmly established.

Methods. We conducted a systematic review and meta-analysis, searching 11 databases (2009 through April 2012) for relevant studies. We used standard methodology conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random effects models.

Results. Regarding mortality we observed a non-significant reduction associated with NAI treatment (at any time) vs none (OR, 0.72 [95% CI, 0.51 - 1.01]). However we observed significant reductions for early treatment (≤48h after symptom onset) vs late (OR, 0.38 [95% CI, 0.27 - 0.53]); and for early treatment vs none (OR, 0.35 [95% CI, 0.18 - 0.71]). NAI treatment (at any time) vs none was associated with an elevated risk of severe outcome (OR, 1.76 [95% CI, 1.22 - 2.54]); but early treatment vs. late reduced the likelihood (OR, 0.41 [95% CI, 0.30 - 0.56]).

Conclusions. During the 2009-10 influenza A(H1N1) pandemic, early initiation of NAI treatment reduced the likelihood of severe outcomes compared with late or no treatment.

http://jid.oxfordjournals.org/content/early/2012/11/28/infdis.jis726.short?rss=1

 

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Re: Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-10 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients

Commentary

The beneficial effects of neuraminidase inhibitor drug therapy on severe patient outcomes
during the 2009‐10 influenza A (H1N1) pandemic.
Fred Y. Aoki1, Frederick G. Hayden2
1Professor of Medicine, Medical Microbiology, And Pharmacology & Therapeutics, University of
Manitoba, Winnipeg, Manitoba, Canada
2Professor of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
Person to whom correspondence should be addressed: Fred Y. Aoki, MD, Room 510 Basic Medical
Sciences Building, 745 Bannatyne Avenue, Winnipeg, Manitoba, Canada, R3E 0J9, Phone: 204‐789‐3625,
Fax: 204‐789‐3926, Email: aokify@cc.umanitoba.ca
Journal of Infectious Diseases Advance Access published November 29, 2012
Accepted Manuscript
2
In this issue of the Journal, Muthuri, Myles and colleagues answer a question of substantial
contemporary importance to clinicians and public health decision makers, namely, whether
antiviral drug therapy of influenza can reduce severe outcomes of the disease in hospitalized
patients (1). In a welcome affirmation of the effectiveness of neuraminidase inhibitor (NAI)
treatment, they report that a meta‐analysis of 90 observational studies involving 34,895
patients, of whom 85% had laboratory‐confirmed pandemic 2009 H1N1 influenza virus [A
(H1N1) pdm09] infection, indicated that antiviral therapy, principally oseltamivir, initiated
within 48 hours of symptom onset, reduced the likelihood of severe outcomes, namely
admission to a critical care unit or death, by 49 to 65%. The strength of the conclusions resides
both in the methodologic rigor applied to the meta‐analysis of the component studies and the
large numbers of studies and patients analyzed. This finding confirms earlier reports of reduced
mortality with oseltamivir therapy in those hospitalized with seasonal (2) or avian H5N1 (3)
influenza. The findings in the current report also complement observations from ecologic
studies (4). For example, Japan, the country with highest per capita use of NAIs during the 2009
pandemic, also had the lowest case‐fatality rate and, remarkably, no reported deaths in
pandemic H1N1‐infected pregnant women (5,6).

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http://jid.oxfordjournals.org/content/early/2012/11/28/infdis.jis727.short?rss=1