tetano
Editor, Senior Moderator
Lancet Respir Med. 2014 May;2(5):395-404. doi: 10.1016/S2213-2600(14)70041-4. Epub 2014 Mar 19.
Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data.
Muthuri SG1, Venkatesan S1, Myles PR1, Leonardi-Bee J1, Al Khuwaitir TS2, Al Mamun A3, Anovadiya AP4, Azziz-Baumgartner E5, B?ez C6, Bassetti M7, Beovic B8, Bertisch B9, Bonmarin I10, Booy R11, Borja-Aburto VH12, Burgmann H13, Cao B14, Carratala J15, Denholm JT16, Dominguez SR17, Duarte PA18, Dubnov-Raz G19, Echavarria M20, Fanella S21, Gao Z22, G?rardin P23, Giannella M24, Gubbels S25, Herberg J26, Iglesias AL27, Hoger PH28, Hu X29, Islam QT30, Jim?nez MF31, Kandeel A32, Keijzers G33, Khalili H34, Knight M35, Kudo K36, Kusznierz G37, Kuzman I38, Kwan AM39, Amine IL40, Langenegger E41, Lankarani KB42, Leo YS43, Linko R44, Liu P45, Madanat F46, Mayo-Montero E47, McGeer A48, Memish Z49, Metan G50, Mickiene A51, Mikić D52, Mohn KG53, Moradi A54, Nymadawa P55, Oliva ME56, Ozkan M57, Parekh D58, Paul M59, Polack FP60, Rath BA61, Rodr?guez AH62, Sarrouf EB63, Seale AC64, Sertogullarindan B65, Siqueira MM66, Skręt-Magierło J67, Stephan F68, Talarek E69, Tang JW70, To KK71, Torres A72, T?r?n SH73, Tran D74, Uyeki TM75, Van Zwol A76, Vaudry W77, Vidmar T78, Yokota RT79, Zarogoulidis P80; PRIDE Consortium Investigators, Nguyen-Van-Tam JS81.
Author information
Abstract
BACKGROUND:
Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection.
METHODS:
We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling.
FINDINGS:
We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0?81; 95% CI 0?70-0?93; p=0?0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0?48; 95% CI 0?41-0?56; p<0?0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0?50; 95% CI 0?37-0?67; p<0?0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1?23] [95% CI 1?18-1?28]; p<0?0001 for the increasing HR with each day's delay).
INTERPRETATION:
We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection.
FUNDING:
F Hoffmann-La Roche.
Copyright ? 2014 Elsevier Ltd. All rights reserved.
PMID:
24815805
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/24815805
Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data.
Muthuri SG1, Venkatesan S1, Myles PR1, Leonardi-Bee J1, Al Khuwaitir TS2, Al Mamun A3, Anovadiya AP4, Azziz-Baumgartner E5, B?ez C6, Bassetti M7, Beovic B8, Bertisch B9, Bonmarin I10, Booy R11, Borja-Aburto VH12, Burgmann H13, Cao B14, Carratala J15, Denholm JT16, Dominguez SR17, Duarte PA18, Dubnov-Raz G19, Echavarria M20, Fanella S21, Gao Z22, G?rardin P23, Giannella M24, Gubbels S25, Herberg J26, Iglesias AL27, Hoger PH28, Hu X29, Islam QT30, Jim?nez MF31, Kandeel A32, Keijzers G33, Khalili H34, Knight M35, Kudo K36, Kusznierz G37, Kuzman I38, Kwan AM39, Amine IL40, Langenegger E41, Lankarani KB42, Leo YS43, Linko R44, Liu P45, Madanat F46, Mayo-Montero E47, McGeer A48, Memish Z49, Metan G50, Mickiene A51, Mikić D52, Mohn KG53, Moradi A54, Nymadawa P55, Oliva ME56, Ozkan M57, Parekh D58, Paul M59, Polack FP60, Rath BA61, Rodr?guez AH62, Sarrouf EB63, Seale AC64, Sertogullarindan B65, Siqueira MM66, Skręt-Magierło J67, Stephan F68, Talarek E69, Tang JW70, To KK71, Torres A72, T?r?n SH73, Tran D74, Uyeki TM75, Van Zwol A76, Vaudry W77, Vidmar T78, Yokota RT79, Zarogoulidis P80; PRIDE Consortium Investigators, Nguyen-Van-Tam JS81.
Author information
Abstract
BACKGROUND:
Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection.
METHODS:
We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling.
FINDINGS:
We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0?81; 95% CI 0?70-0?93; p=0?0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0?48; 95% CI 0?41-0?56; p<0?0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0?50; 95% CI 0?37-0?67; p<0?0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1?23] [95% CI 1?18-1?28]; p<0?0001 for the increasing HR with each day's delay).
INTERPRETATION:
We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection.
FUNDING:
F Hoffmann-La Roche.
Copyright ? 2014 Elsevier Ltd. All rights reserved.
PMID:
24815805
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/24815805