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Webster - Flu expert says doctors are misusing antiviral drugs

sharon sanders

sharon sanders

Editor-in-Chief & President
Flu expert says doctors are misusing antiviral drugs <dl class="byline">By Trine Tsouderos |Tribune staff reporter<dd>5:35 PM CST, March 6, 2009</dd></dl> Flu news is going around. Just this week, scientists detailed how one of our go-to flu drugs, Tamiflu, no longer works against this year's most common strain, while other researchers announced exciting new advances in the development of influenza vaccines.

With flu on the brain, we called one of the world's leading experts on the topic, Robert Webster, chair of infectious diseases at St. Jude's Children's Research Hospital in Memphis. Among other achievements, Webster helped discover wild birds are "reservoirs" for the influenza virus.

In the interview, Webster railed against the way antiviral medications are being used and warned that we would burn through our available medicines if we weren't careful. Here's more of what he had to say:

On why we shouldn't use just one drug -- Relenza -- to replace Tamiflu when treating this particular strain of flu, as the Centers for Disease Control recommends:

"The future for antivirals for the flu is the use of combination therapy. Nature is teaching us a lesson here. We should have learned from HIV that if you use mono-therapy drugs, you are asking for trouble.....

more....


http://www.chicagotribune.com/features/lifestyle/health/chi-flu-expert-interview-06-,0,3652022.story



 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

www.chicagotribune.com/features/lifestyle/health/chi-flu-expert-interview-06-,0,3652022.story
chicagotribune.com

Flu expert says doctors are misusing antiviral drugs

By Trine Tsouderos
Tribune staff reporter
5:35 PM CST, March 6, 2009


Flu news is going around. Just this week, scientists detailed how one of our go-to flu drugs, Tamiflu, no longer works against this year's most common strain, while other researchers announced exciting new advances in the development of influenza vaccines.

With flu on the brain, we called one of the world's leading experts on the topic, Robert Webster, chair of infectious diseases at St. Jude's Children's Research Hospital in Memphis. Among other achievements, Webster helped discover wild birds are "reservoirs" for the influenza virus.

In the interview, Webster railed against the way antiviral medications are being used and warned that we would burn through our available medicines if we weren't careful. Here's more of what he had to say:

On why we shouldn't use just one drug -- Relenza -- to replace Tamiflu when treating this particular strain of flu, as the Centers for Disease Control recommends:

"The future for antivirals for the flu is the use of combination therapy. Nature is teaching us a lesson here. We should have learned from HIV that if you use mono-therapy drugs, you are asking for trouble. It is a stats game. If you use one drug, you will get resistance. But if you use two, it squares your chances. And with three, the chance of resistance goes down, and if you have four, you have a combination that goes on for years and years. With flu, we don't have that luxury, but we can use them in combination already. And we are not doing so."

On why Relenza is just going to end up like Tamiflu, losing its effectiveness:

"We are going to blow it. We are going to waste it. We would really be remiss, and the authorities need a kick in the [behind] if they do that. They will waste the potential. If you use [Relenza] on a regular basis and in the face of a large-scale pandemic, you will get resistance, guaranteed. We know in principle what to do, so why aren't we doing it? There is no good reason."

On what lesson we should learn from Tamiflu resistance:

"Flu is in control and sending us a message. Despite all of our knowledge -- we think we have universal vaccines and universal drugs -- the virus will change. It has the capacity to change constantly all of the time. It can outwit us."
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

niman said:
www.chicagotribune.com/features/lifestyle/health/chi-flu-expert-interview-06-,0,3652022.story
chicagotribune.com

Flu expert says doctors are misusing antiviral drugs


On what lesson we should learn from Tamiflu resistance:

"Flu is in control and sending us a message. Despite all of our knowledge -- we think we have universal vaccines and universal drugs -- the virus will change. It has the capacity to change constantly all of the time. It can outwit us."
Click to expand...

Although there is little to no evidence that H274Y levels in H1N1 is related to treating H1N1 with oseltamivir, the ability of the virus to defeat a universal vaccione was VERY clear in the Nature paper on a universal treatment.

It is also worth noting that the "Universal" treatment was direct at the SAME determinants in both recent papers (using a library from a niave host or one challenged with seasonal flu), so ONE change can defeat both.
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

From A. Moscona paper:

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

On different oseltamivir and zanamivir mechanism of action:

<table style="width: auto;"><tbody><tr><td></td></tr><tr><td style="font-family: arial,sans-serif; font-size: 11px; text-align: right;">From TABLES</td></tr></tbody></table>

See also: http://www.flutrackers.com/forum/showthread.php?t=95958
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

It is worth repeating that in the above cartoon, N295S is also listed as one of the changes that inhibits oseltamivir, and N294S was found in H5N1 in the Gharbiya cluster prior to treatment, indicating N294S did not impose a significant fitness penalty (all three patients died), yet neither N294S or other resistance markers have been found at appreciable levels in seasonal flu.
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

experts won't tell us directly ... so we have to "interpret" their
statements. Apparantly Webster believes that current resistance was
caused by Tamiflu use.
How about Amantadine resistance ?

Same pattern, it appeared just after widespread use of the drugs.

Still no direct sign of causual connection.
So, what do experts believe ?

When there are no statements let us connect indirect opinions !
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

gsgs said:
experts won't tell us directly ... so we have to "interpret" their
statements. Apparantly Webster believes that current resistance was
caused by Tamiflu use.
How about Amantadine resistance ?

Same pattern, it appeared just after widespread use of the drugs.

Still no direct sign of causual connection.
So, what do experts believe ?

When there are no statements let us connect indirect opinions !
Click to expand...
The problems associated with monotherapy are well known. There is no data supporting H274Y expansion linked to Tamiflu usage in seasonal flu.

Anyone who thinks H274Y is linked to Tamiflu usage in seasonal flu is NOT an expert in this area.
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

Dr. Webster?s warning is addressed to Japan, No.1 consumer of Tamiflu for
many years. (They say 70-80% of Tamiflu is consumed by Japanese.)
It was only a luck that Japan did not create the current Tamiflu-resistant
virus.

In Japan some doctors like Dr. Oomagari share Dr. Webster?s concern about
the misuse of Tamiflu.

Source: http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468.html
http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468_2.html
http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468_3.html

(Quote)
Dr. Oomagari:
Many people fear too much about Tamiflu-resistant virus and they don?t
understand its real impact on society.

There are several points to cover:
1) Obsession in taking medicine.
Seasonal flu is naturally curable disease for healthy people. Tamiflu only
benefit them in reducing the duration and severity of influenza. You will not
die for not taking anti-virals.
However, many people in Japan simply believe that they should take anti-
virals. Japan consumes too much Tamiflu in the world. There are some
doctors calling for an appropriate use of antivirals. Unfortunately, they are in
a minority.

2) Hasty conclusion that Tamiflu?s ineffective against the resistant virus.
Real effectiveness of Tamiflu against the resistant virus is still unknown.
Unlike laboratory results, clinical results are yet to come. We need to study
the clinical data about Tamiflu?s real effectiveness afer this season.
(Unquote)

Some people in Japan also say that because we overuse Tamiflu in Japan, we
have too many cases of unusual behavior in teenagers and that eventually
led us ban Tamiflu treatment for teenagers. This should be another adverse
effect of the overuse.

__________________________
SN1987A
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

SuperNova1987A said:
Dr. Webster’s warning is addressed to Japan, No.1 consumer of Tamiflu for
many years. (They say 70-80% of Tamiflu is consumed by Japanese.)
It was only a luck that Japan did not create the current Tamiflu-resistant
virus.

In Japan some doctors like Dr. Oomagari share Dr. Webster’s concern about
the misuse of Tamiflu.

Source: http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468.html
http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468_2.html
http://medical.nikkeibp.co.jp/leaf/mem/pub/opinion/orgnl/200902/509468_3.html

(Quote)
Dr. Oomagari:
Many people fear too much about Tamiflu-resistant virus and they don’t
understand its real impact on society.

There are several points to cover:
1) Obsession in taking medicine.
Seasonal flu is naturally curable disease for healthy people. Tamiflu only
benefit them in reducing the duration and severity of influenza. You will not
die for not taking anti-virals.
However, many people in Japan simply believe that they should take anti-
virals. Japan consumes too much Tamiflu in the world. There are some
doctors calling for an appropriate use of antivirals. Unfortunately, they are in
a minority.

2) Hasty conclusion that Tamiflu’s ineffective against the resistant virus.
Real effectiveness of Tamiflu against the resistant virus is still unknown.
Unlike laboratory results, clinical results are yet to come. We need to study
the clinical data about Tamiflu’s real effectiveness afer this season.
(Unquote)

Some people in Japan also say that because we overuse Tamiflu in Japan, we
have too many cases of unusual behavior in teenagers and that eventually
led us ban Tamiflu treatment for teenagers. This should be another adverse
effect of the overuse.

__________________________
SN1987A
Click to expand...
Overuse of Tamiflu leads to changes in multiple serotypes at multiple positions. There is no evidence of such changes in H3N2, in spite of EXTENSIVE analysis of samples collected over the past SEVERAL years.

There is NO evidence to support the spread of H274Y through inappropriate use of Tamiflu to treat seasonal flu.
 
Re: Webster - Flu expert says doctors are misusing antiviral drugs

niman said:
Overuse of Tamiflu leads to changes in multiple serotypes at multiple positions. There is no evidence of such changes in H3N2, in spite of EXTENSIVE analysis of smaples collected over the past SEVERAL years.

There is NO evidence to support the spread of H274Y thrfough inappropriate use of Tamiflu to treat seasonal flu.
Click to expand...


Thank you, Dr. Niman, for clarification.

I agree with you. And I meant almost the same thing by saying "It was only a
luck that Japan did not create the current Tamiflu-resistant virus."


_________________
SN1987A
 
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