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

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 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.

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)].

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.