Neuraminidase inhibitors for preventing and treating influenza in healthy adults

Jefferson, Tom, Demicheli, Vittorio, Di Pietrantonj, Carlo, Jones, Mark and Rivetti, Daniela (2006) Neuraminidase inhibitors for preventing and treating influenza in healthy adults. Cochrane Database of Systematic Reviews, 3: 1-53. doi:10.1002/14651858.CD001265.pub2

Author Jefferson, Tom
Demicheli, Vittorio
Di Pietrantonj, Carlo
Jones, Mark
Rivetti, Daniela
Title Neuraminidase inhibitors for preventing and treating influenza in healthy adults
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2006
Sub-type Article (original research)
DOI 10.1002/14651858.CD001265.pub2
Issue 3
Start page 1
End page 53
Total pages 53
Place of publication Sussex
Publisher John Wiley & Sons
Collection year 2006
Language eng
Subject C1
321027 Respiratory Diseases
320503 Clinical Pharmacology and Therapeutics
730110 Respiratory system and diseases (incl. asthma)
730213 Preventive medicine
Formatted abstract
Neuraminidase inhibitors (NI) are recommended for use against influenza and its complications in interpandemic years and in a pandemic.

To assess the effects of NIs in preventing or ameliorating influenza, its transmission and its complications in healthy adults and to estimate the frequency of adverse effects.

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 2) which contains the Acute Respiratory Infections Group's Specialized Register, MEDLINE (2005 to May, Week 4 2005), and EMBASE (2005 to May 2008).

Selection criteria
Randomised or quasi-randomised placebo-controlled studies of NIs in healthy adults exposed to naturally occurring influenza.

Data collection and analysis
Two review authors applied inclusion criteria, assessed trial quality and extracted data. We structured the comparisons into prophylaxis, treatment and adverse events with further subdivision by outcome and dose.

Main results
We identified four prophylaxis, 13 treatment and four post-exposure prophylaxis (PEP) trials. In prophylaxis compared to placebo, NIs have no effect against influenza-like illnesses (ILI) (relative risk (RR) 1.28, 95% confidence interval (CI) 0.45 to 3.66 for oral oseltamivir 75 mg daily; RR 1.51, 95% CI 0.77 to 2.95 for inhaled zanamivir 10 mg daily). The efficacy of oral oseltamivir 75 mg daily against symptomatic influenza is 61% (RR 0.39, 95% CI 0.18 to 0.85), or 73% (RR 0.27, 95% CI 0.11 to 0.67) at 150 mg daily. Inhaled zanamivir 10 mg daily is 62% efficacious (RR 0.38, 95% CI 0.17 to 0.85). Neither NI has a significant effect on asymptomatic influenza. Oseltamivir induces nausea (odds ratio (OR) 1.79, 95% CI 1.10 to 2.93). Oseltamivir for PEP has an efficacy of 58.5% (15.6% to 79.6) for households and of 68% (34.9 to 84.2%) to 89% in contacts of index cases. Zanamivir has similar performance. The hazard ratios for time to alleviation of influenza symptoms were in favour of the treated group 1.33 (1.29 to 1.37) for zanamivir and 1.30 (1.13 to 1.50) for oseltamivir. Viral nasal titres were significantly diminished by both NIs. Oseltamivir 150 mg daily prevented lower respiratory tract complications (OR 0.32, 95% CI 0.18 to 0.57). We could find no comparative data on the effects of oseltamivir on avian influenza.

Authors' conclusions
Because of their low effectiveness, NIs should not be used in routine seasonal influenza control. In a serious epidemic or pandemic, NIs should be used with other public health measures. We are unsure of the generalisability of our conclusions from seasonal to pandemic or avian influenza.
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2007 Higher Education Research Data Collection
School of Medicine Publications
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Created: Wed, 15 Aug 2007, 10:08:42 EST