Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an IPD meta-analysis

Muthuri, Stella G. and Venkatesan, Sudhir and Myles, Puja R. and Leonardi-Bee, Jo and Lim, Wei Shen and Mamun, Abdullah Al and Anovadiya, Ashish P. and Araújo, Wildo N. and Azziz-Baumgartner, Eduardo and Báez, Clarisa and Bantar, Carlos and Barhoush, Mazen M. and Bassetti, Matteo and Beović, Bojana and Bingisser, Roland and Bonmarin, Isabelle and Borja-Aburto, Victor H. and Cao, Bin and Carratala, Jordi and Cuezzo, María R. and Denholm, Justin T. and Dominguez, Samuel R. and Duarte, Pericles A. D. and Dubnov-Raz, Gal and Echavarria, Marcela and Fanella, Sergio and Fraser, James and Gao, Zhancheng and Gérardin, Patrick and Giannella, Maddalena and Gubbels, Sophie and Herberg, Jethro and Higuera Iglesias, Anjarath L. and Hoeger, Peter H. and Hoffmann, Matthias and Hu, Xiaoyun and Islam, Quazi T. and Jiménez, Mirela F. and Kandeel, Amr and Keijzers, Gerben and Khalili, Hossein and Khandaker, Gulam and Knight, Marian and Kusznierz, Gabriela and Kuzman, Ilija and Kwan, Arthur M. C. and Lahlou Amine, Idriss and Langenegger, Eduard and Lankarani, Kamran B. and Leo, Yee-Sin and Linko, Rita and Liu, Pei and Madanat, Faris and Manabe, Toshie and Mayo-Montero, Elga and McGeer, Allison and Memish, Ziad A. and Metan, Gokhan and Mikić, Dragan and Mohn, Kristin G. I. and Moradi, Ahmadreza and Nymadawa, Pagbajabyn and Ozbay, Bulent and Ozkan, Mehpare and Parekh, Dhruv and Paul, Mical and Poeppl, Wolfgang and Polack, Fernando P. and Rath, Barbara A. and Rodríguez, Alejandro H. and Siqueira, Marilda M. and Skręt-Magierło, Joanna and Talarek, Ewa and Tang, Julian W. and Torres, Antoni and Törün, Selda H. and Tran, Dat and Uyeki, Timothy M. and van Zwol, Annelies and Vaudry, Wendy and Velyvyte, Daiva and Vidmar, Tjasa and Zarogoulidis, Paul and Nguyen-Van-Tam, Jonathan S. (2015) Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an IPD meta-analysis. Influenza and Other Respiratory Viruses, 10 (3). pp. 192-204. ISSN 1750-2640

PDF - Published Version Download (336kB)

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. ----- 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.

Actions (login required)

View Item

Downloads