title: Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia
title: an individual participant data meta-analysis
titleType: Subtitle
Creators: name: Muthuri, Stella G.
name: Venkatesan, Sudhir
name: Myles, Puja R.
name: Leonardi-Bee, Jo
name: Lim, Wei Shen
name: Al Mamun, Abdullah
name: Anovadiya, Ashish P.
name: Araujo, Wildo N.
name: Azziz-Baumgartner, Eduardo
name: Baez, Clarisa
name: Bantar, Carlos
name: Barhoush, Mazen M.
name: Bassetti, Matteo
name: Beovic, Bojana
name: Bingisser, Roland
name: Bonmarin, Isabelle
name: Borja-Aburto, Victor H.
name: Cao, Bin
name: Carratala, Jordi
name: Cuezzo, Maria R.
name: Denholm, Justin T.
name: Dominguez, Samuel R.
name: Duarte, Pericles A. D.
name: Dubnov-Raz, Gal
name: Echavarria, Marcela
name: Fanella, Sergio
name: Fraser, James
name: Gao, Zhancheng
name: Gerardin, Patrick
name: Giannella, Maddalena
name: Gubbels, Sophie
name: Herberg, Jethro
name: Higuera Iglesias, Anjarath L.
name: Hoeger, Peter H.
name: Hoffmann, Matthias
name: Hu, Xiaoyun
name: Islam, Quazi T.
name: Jimenez, Mirela F.
name: Kandeel, Amr
name: Keijzers, Gerben
name: Khalili, Hossein
name: Khandaker, Gulam
name: Knight, Marian
name: Kusznierz, Gabriela
name: Kuzman, Ilija
name: Kwan, Arthur M. C.
name: Lahlou Amine, Idriss
name: Langenegger, Eduard
name: Lankarani, Kamran B.
name: Leo, Yee-Sin
Publisher: name: Charité - Universitätsmedizin Berlin
Year: 2016
Subjects: subject: Hospitalisation
subject: individual participant data meta-analyses
subject: influenza-related pneumonia
subject: neuraminidase inhibitors
subject: 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit

description: 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.