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The Lancet: Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1

tetano

tetano

Editor, Senior Moderator
Summary
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.

full article

http://download.thelancet.com/flatcontentassets/pdfs/S2213260014700414.pdf
 
Re: The Lancet: Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1

Roche-backed study finds Tamiflu saved lives in flu pandemic

LONDON Tue Mar 18, 2014 8:02pm EDT
Credit: Reuters/Ruben Sprich

(Reuters) - Using Roche's medicine Tamiflu saved lives during the H1N1 swine flu pandemic four years ago, according to a new scientific study published on Wednesday.

The pooled analysis of data, involving more than 29,000 patients from 38 countries, was funded by the Swiss drugmaker which hopes the findings will reassure governments about the value of its flu drug following criticism from some doctors.

Jonathan Nguyen-Van-Tam of the University of Nottingham and colleagues found that treatment with neuraminidase inhibitor drugs - principally Tamiflu - reduced the risk of death during the pandemic by 19 percent compared with no treatment.

The greatest benefit was seen when treatment was started within two days of symptoms developing, when the risk of death was halved, they reported in the journal Lancet Respiratory Medicine.

The same survival benefit was evident in pregnant women and adults in intensive care. However, the researchers observed no significant mortality reduction in children.
...
http://www.reuters.com/article/2014/03/19/us-roche-tamiflu-idUSBREA2I00720140319
 
Re: The Lancet: Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1

Flu Drugs Saved Lives During 2009 Pandemic

by Richard Harris
March 18, 2014 6:32 PM

Drugs used to treat the flu really did save the lives of seriously ill people during the influenza pandemic of 2009-2010, a study in The Lancet Respiratory Medicine suggests.
...
Nguyen-Van-Tam's study found that adults who were treated with the drug within two days of diagnosis reduced their risk of death by half, compared with people who didn't get treated at all. And promptness counts.
...
"As expected, early treatment seems to be optimal, and treatment shouldn't be delayed by even one day to wait for diagnostic test results," writes Alicia Fry of the CDC, in an editorial accompanying the study. She adds that there still might be some benefit treating people after that, especially if they are severely ill.

Children didn't benefit so clearly from treatment. The study hinted that the drug reduced the risk of death among children, but the effect was too weak to measure with confidence. Still, Dr. Fry writes that it's worth treating children because the potential benefits outweigh the drugs' low risks.
...
The study was funded by Hoffman La Roche, which owns Genentech, the maker of Tamiflu. That's a sensitive point because other scientists have struggled to get data out of Roche in order to make an independent assessment of Tamiflu.

Anticipating raised eyebrows, the paper says: "The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The funder has not and will never have access to the data."

http://www.npr.org/blogs/health/2014/03/18/291134472/anti-flu-drugs-saved-lives-during-2009-pandemic
 
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