Marek Smieja, MD, PhD
Are neuraminidase inhibitors effective for preventing or treating influenza in adults and children who are not immunocompromised? What are the harms?
Included studies compared neuraminidase inhibitors with placebo or standard care as prophylaxis, postexposure prophylaxis, or treatment of naturally occurring influenza in previously healthy adults and children, including those with chronic illness, and had available unabridged clinical study report (CSR) modules. Exclusion criteria included illness affecting immune responses. Primary outcomes included symptom relief, hospitalization, complications, and harms.
MEDLINE (from May 2009); EMBASE/Excerpta Medica (from Jan 2010); Cochrane Central Register of Controlled Trials, DARE, and NHSEED; US Food and Drug Administration, European Medicines Agency, UK National Institute for Health and Clinical Excellence, and Japanese Pharmaceutical and Medical Devices Agency documents; previous reviews and health technology assessments; trial registries; and drug product information sheets (all to 12 Apr 2011) were searched to identify published and unpublished randomized controlled trials (RCTs). Regulatory organizations and pharmaceutical companies were contacted for CSRs of RCTs and associated regulatory documents. 25 RCTs met inclusion criteria and had available CSRs: 15 evaluated oseltamivir (n = 9030 in 14 RCTs; mean age 5 to 82 y, and 41% to 69% women in 13 RCTs), and 10 evaluated zanamivir. Insufficient data were available or unresolved discrepancies existed for 42 additional RCTs. Meta-analyses were done for trials of oseltamivir; this abstract focuses on these results. 10 trials evaluated oseltamivir as treatment for influenza, 3 as prophylaxis, and 1 as postexposure prophylaxis; 1 evaluated safety. All included studies were sponsored by drug manufacturers; 11 trials of oseltamivir had adequate allocation concealment; 7 blinded participants, study personnel, and outcome assessors; and 14 had adequate outcome data for ≥ 1 outcome.
Meta-analysis showed that oseltamivir reduced time to first relief of influenza-like symptoms compared with placebo; groups did not differ for hospitalizations (Table). Oseltamivir increased nausea and vomiting but reduced diarrhea (Table). Data were insufficient to evaluate the effect of neuraminidase inhibitors on influenza complications.
In adults and children who are not immunocompromised, oseltamivir relieves influenza-like symptoms faster than placebo but does not reduce hospitalizations.
Oseltamivir vs placebo in nonimmunocompromised adults and children*
*RRR, RRI, NNT, NNH, and CI calculated from data in article using a random-effects model. All RCTs were done in treatment settings unless otherwise indicated.
†Oseltamivir was used for postexposure prophylaxis in 1 RCT (n = 955).
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Smieja M. Review: Oseltamivir relieves symptoms but does not reduce hospitalizations in influenza. Ann Intern Med. 2012;157:JC3–5. doi: 10.7326/0003-4819-157-6-201209180-02005
Download citation file:
Published: Ann Intern Med. 2012;157(6):JC3-5.
Hospital Medicine, Infectious Disease, Influenza, Prevention/Screening, Pulmonary/Critical Care.
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use