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Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis.
- Source :
-
Influenza and other respiratory viruses [Influenza Other Respir Viruses] 2016 May; Vol. 10 (3), pp. 192-204. Date of Electronic Publication: 2016 Feb 01. - Publication Year :
- 2016
-
Abstract
- 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.<br />Methods: A worldwide meta-analysis of individual participant data 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 IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.<br />Results: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the 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 5978 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)].<br />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.<br /> (© 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)
- Subjects :
- Adolescent
Adrenal Cortex Hormones therapeutic use
Adult
Anti-Bacterial Agents therapeutic use
Child
Child, Preschool
Enzyme Inhibitors therapeutic use
Female
Humans
Influenza, Human epidemiology
Influenza, Human mortality
Influenza, Human virology
Male
Middle Aged
Odds Ratio
Pneumonia, Viral diagnostic imaging
Pneumonia, Viral epidemiology
Treatment Outcome
Young Adult
Antiviral Agents therapeutic use
Influenza A Virus, H1N1 Subtype drug effects
Influenza A Virus, H1N1 Subtype enzymology
Influenza, Human drug therapy
Neuraminidase antagonists & inhibitors
Pneumonia, Viral drug therapy
Pneumonia, Viral virology
Subjects
Details
- Language :
- English
- ISSN :
- 1750-2659
- Volume :
- 10
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Influenza and other respiratory viruses
- Publication Type :
- Academic Journal
- Accession number :
- 26602067
- Full Text :
- https://doi.org/10.1111/irv.12363