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February 11, 2015
Meta-analysis: Oseltamivir Reduces Flu Duration, Lowers Hospitalization Rates
Ann Arbor, MI—Oseltamivir, marketed as Tamiflu, has been a hot commodity this winter, with some areas even reporting temporary supply issues because of the severe influenza season. The question, however, has been how effectively the drug decreases the course of the illness. The answer, according to a new meta-analysis, is that the antiviral shortens the duration of flu symptoms by about a day in adults with laboratory-confirmed influenza. The report, published in The Lancet, also indicates that oseltamivir significantly reduces the risk of hospitalization from the flu as well as influenza complications requiring antibiotics, such as pneumonia. For the first time, the meta-analysis includes individual patient data from all published and unpublished trials, which were made available by the Swiss manufacturer, Roche, according to the authors. “The safety and effectiveness of oseltamivir has been hotly debated, with some researchers claiming there is little evidence that oseltamivir works,” according to lead researcher Arnold Monto, MD, professor of epidemiology at the University of Michigan School of Public Health. “Our meta-analysis provides compelling evidence that oseltamivir therapy reduces by one day the typical length of illness in adults infected with influenza and also prevents complications and reduces the number of people needing hospital treatment. Whether the magnitude of these benefits outweigh the harms of nausea and vomiting needs careful consideration.” For the study, researchers analyzed data from nine trials comparing the licensed 75-mg dose of oseltamivir with placebo for the treatment of seasonal influenza in 4,328 adults between 1997 and 2001. The review found that, in that situation, oseltamivir reduced the duration of symptoms by 21% compared with placebo—from 123 hours to 98 hours. On the other hand, oseltamivir treatment was found to increase the risk of nausea (absolute increase 3.7%) and vomiting (4.7%) compared with placebo. Although neurological and psychological disorders previously were linked with the drug, the researchers found no differences between the treatment and control groups in those areas. Overall, the authors note, rates of complications were low, with oseltamivir reducing the risk of lower respiratory tract infections requiring antibiotics more than 48 hours after study entry by 44% compared with placebo (4.9% vs. 8.7%), and hospital admission for any cause by 63% (0.6% vs. 1.7%) in adults with laboratory-confirmed influenza. “This is the first patient-level analysis of how well this drug works. Previous research has questioned its success and use in light of the side effects of nausea and vomiting, but the other studies combined those infected with influenza and those without, which diluted the positive effect in treatment,” Monto explained. Writing in a linked comment, Heath Kelly, MPH, from the Australian National University in Canberra and Benjamin Cowling, PhD, from The University of Hong Kong, suggest rapid diagnostic testing, if possible, before administering oseltamivir in routine clinical practice “because benefits accrue only to patients with laboratory-confirmed influenza, but the risk of adverse events is increased in all patients.” “In a pandemic or severe epidemic,” Kelly and Cowling add, “oseltamivir can be used presumptively when there is a high probability that influenza-like illness is caused by influenza virus infection and when the outcome of infection is likely to be severe, but a proven strategy for rapid distribution needs to accompany any plan that proposes widespread use of oseltamivir.”
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