Benefit of Early Oseltamivir Therapy for Adults Hospitalized With Influenza A: An Observational Study
Authors: Lewis Nathaniel M , Harker Elizabeth J , Grant Lauren B , Zhu Yuwei , Grijalva Carlos G , Chappell James D , Rhoads Jillian P , Baughman Adrienne , Casey Jonathan D , Blair Paul W , Jones Ian D , Johnson Cassandra A , Lauring Adam S , Gaglani Manju , Ghamande Shekhar , Columbus Cristie , Steingrub Jay S , Shapiro Nathan I , Duggal Abhijit , Busse Laurence W , Felzer Jamie , Prekker Matthew E , Peltan Ithan D , Brown Samuel M , Hager David N , Gong Michelle N , Mohamed Amira , Exline Matthew C , Khan Akram , Hough Catherine L , Wilson Jennifer G , Mosier Jarrod , Qadir Nida , Chang Steven Y , Ginde Adit A , Martinez Amanda , Mohr Nicholas M , Mallow Christopher , Harris Estelle S , Johnson Nicholas J , Srinivasan Vasisht , Gibbs Kevin W , Kwon Jennie H , Vaughn Ivana A , Ramesh Mayur , Safdar Basmah , Goyal Anirudh , DeLamielleure Lauren E , DeCuir Jennifer , Surie Diya , Dawood Fatimah S , Tenforde Mark W , Uyeki Timothy M , Garg Shikha , Ellington Sascha , Self Wesley H ,   for the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network, Gaglani Manjusha , McNeal Tresa , Calhoun Shekhar Ghamande Nicole , Murthy Kempapura , Cravens Joselyn , Herrick Judy , McKillop Amanda , Hoffman Eric , Graves Ashley , Zayed Martha , Smith Michael , Gaglani Manjusha , Columbus Cristie , Bychkowski Ashley , Dunkley Symone , Fisher Tammy , Grefsrud Therissa , Hurutado-Rodriguez Mariana , Perez Gabriela , Busse Laurence , ten Lohuis Caitlin , Felzer Jamie , Prekker Matthew , Hendrickson Audrey , Frosch Anne , Taghizadeh Leyla , Hurreh Kowsar , O'Rourke Mary , Giles Laurynn , Vaughn Ivana A , Ramesh Mayur , Lamerato Lois E , Almawri Khaled , Atkins Ishraaq , Clark Jaleesa , Lava Jean Ashley , McKeon Catherine , Pinderi Zina , Resk Melissa , Koneru Sindhuja , Jayaprakash Rachna , Tirumala Shruti , Williams Katrina , Peltan Ithan , Lumpkin Jenna , Poulson Shandi , Bassett Joslyn , Thumma Vineela , Hager David N , Ali Harith , Richard  , Saeed Safa , Mohr Nicholas , Zepeski Anne , Nassar Paul , Hampton Jacob , Fairfield Cathy , Gibbs Heath , Feitsam Courtney , Appleton Ike , Gong Michelle Ng , Mohamed Amira , Andrea Luke , Exline Matthew , Karow Sarah , Swoope Gabrielle , So Madison , Pathak Manisha , Smith David , Wilson Reece , Lewald Zachery , Snyder Connor , Khan Maryiam , Lee Brooke , Rasul Amanie , Khan Akram , Hernandez-Frausto Adrian , Pocius Edvinas , Tribbett Emily , Briceno Genesis , Pena Jose , Pellicer Sarah , Reddy Raju , Allada Gopal , Wilson Jennifer , Gordon Alexandra June , Perez Cynthia , Lau Lilian , Ferguson Samantha , Pitre Vanessa , Tam Grace , Basobas Leonard , Mosier Jarrod , Lutrick Karen , Hypes Cameron , Campbell Beth Salvagio , Ginde Adit , Martinez Amanda , Steinwand Aimee , Sullivan Amy , Withers Cori , Rademacher Jacob , Obradovich Rachel , Mallow Chris , Rivas Carolina , Johnson Nicholas , Acidera Joshua , Elkort Katherine , Gajendragadkar Amol , McKeown Maile , Self Wesley H , Keipp Talbot H , Grijalva Carlos , Blair Paul W , Jones Ian D , Halasa Natasha , Chappell James D , Womack Kelsey N , Rhoads Jillian , Ratcliff Colleen , Baughman Adrienne , Johnson Jakea , Swan Sydney , Johnson Cassandra , Zhu Yuwei , Rice Todd W , Casey Jonathan D , Zhu Yuwei , Short Laura L , Ezzell Lauren J , Whitsett Margaret E , McHenry Rendie E , Hargrave Samarian J , Luther Jennifer L , Pulido Claudia Guevara , Peterson Bryan P M , Cummings Shanice L , Gauthier Emma Claire , Jackson Anna C , Rashid Neekar S , Blair Marcia , Rice Caroline , Kwon Jennie , Parikh Bijal , McDonald David , Samuels Carleigh , Vogt Lucy , O'Neil Caroline , Valencia Alyssa , Yerbic Francesca , Arter Olivia , Vu Kim , Safdar Basmah , Goyal Anirudh , DeLamielleure Lauren , Kosover Michael 
Published: November 2024

Abstract

Background
Clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza.

Methods
A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during 1 October 2022–21 July 2023. A multivariable proportional odds model was used to compare peak pulmonary disease severity (no oxygen support, standard supplemental oxygen, high-flow oxygen/non-invasive ventilation, invasive mechanical ventilation, or death) after the day of hospital admission among patients starting oseltamivir treatment on the day of admission (early) versus those who did not (late or not treated), adjusting for baseline (admission day) severity, age, sex, site, and vaccination status. Multivariable logistic regression models were used to evaluate the odds of intensive care unit (ICU) admission, acute kidney replacement therapy or vasopressor use, and in-hospital death.

Results
A total of 840 influenza-positive patients were analyzed, including 415 (49%) who started oseltamivir treatment on the day of admission, and 425 (51%) who did not. Compared with late or not treated patients, those treated early had lower peak pulmonary disease severity (proportional adjusted odds ratio [aOR]: 0.60, 95% confidence interval [CI]: .49–.72), and lower odds of intensive care unit admission (aOR: 0.24, 95% CI: .13–.47), acute kidney replacement therapy or vasopressor use (aOR: 0.40, 95% CI: .22–.67), and in-hospital death (aOR: 0.36, 95% CI: .18–.72).

Conclusions
Among adults hospitalized with influenza, treatment with oseltamivir on day of hospital admission was associated reduced risk of disease progression, including pulmonary and extrapulmonary organ failure and death.