Journal article
Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an IPD meta-analysis.
- Abstract:
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Background
The impact of neuraminidase inhibitors (NAIs) on Influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.
Methods
A worldwide meta-analysis of individual participant data (IPD) from 20,634 hospitalised patients with laboratory confirmed A(H1N1)pdm09 (n=20,021) or clinically diagnosed (n=613) ‘pandemic influenza’. The primary outcome was radiologically confirmed influenza-related pneumonia (IRP). Odds ratios (OR) were estimated using generalized linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.
Results
Among 20,634 included participants, 5,978 (29.0%) had IRP; conversely, 3,349 (16.2%) had confirmed absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0.83 (95%CI 0.64 – 1.06; p=0.136)]. Among the 5,978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR=0.72 (0.44-1.17; p=0.180)] or likelihood of requiring ventilatory support [adj. OR=1.17 (0.71-1.92; p=0.537)]; but early treatment versus later significantly reduced mortality [adj. OR=0.70 (0.55-0.88; p=0.003)] and likelihood of requiring ventilatory support [adj. OR=0.68 (0.54-0.85; p=0.001)].
Conclusions
Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, pdf, 847.5KB, Terms of use)
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- Publisher copy:
- 10.1111/irv.12363
Authors
- Publisher:
- Wiley
- Journal:
- Influenza and Other Respiratory Viruses More from this journal
- Volume:
- 10
- Issue:
- 3
- Pages:
- 192–204
- Publication date:
- 2016-02-01
- Acceptance date:
- 2015-11-09
- DOI:
- EISSN:
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1750-2659
- ISSN:
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1750-2640
- Language:
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English
- Keywords:
- Pubs id:
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pubs:581991
- UUID:
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uuid:f1edb718-516b-4030-bd08-ab7ed3b249e7
- Local pid:
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pubs:581991
- Source identifiers:
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581991
- Deposit date:
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2016-04-04
- ARK identifier:
Terms of use
- Copyright holder:
- Knight et al
- Copyright date:
- 2016
- Notes:
- © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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