Antivirals for Treatment of Influenza
Authors: Mark A. Jones, Rokuro Hama, Chris Del Mar
Journal: Annals of Internal Medicine (2012)

Letters4 September 2012Antivirals for Treatment of InfluenzaMark A. Jones, PhD, Rokuro Hama, MD, and Chris Del Mar, MDMark A. Jones, PhDFrom University of Queensland School of Population Health, Brisbane, Queensland 4006, Australia.Search for more papers by this author, Rokuro Hama, MDFrom University of Queensland School of Population Health, Brisbane, Queensland 4006, Australia.Search for more papers by this author, and Chris Del Mar, MDFrom University of Queensland School of Population Health, Brisbane, Queensland 4006, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-5-201209040-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their meta-analysis of observational studies, Hsu and colleagues (1) report that oral oseltamivir reduces mortality with an odds ratio of 0.23 (95% CI, 0.13 to 0.43)—low-quality evidence. This result is based on 3 studies. One is published only as a conference abstract and lacks detail (2). The second study conducted logistic regression and Kaplan–Meier analysis from the onset of symptoms to 30 days after illness onset (3); this then creates an important bias that has the potential to reverse their findings. Similar problems exist in the third study (4).Although median time from symptom onset to ...References1. Hsu J, Santesso N, Mustafa R, Brozek J, Chen YL, Hopkins JP, et al. Antivirals for treatment of influenza: a systematic review and meta-analysis of observational studies. Ann Intern Med. 2012;156:512-24. [PMID: 22371849] LinkGoogle Scholar2. McGeer A, Green K, Drews S, Davis I, Downey J, Katz K, et al. Epidemiology of influenza illness requiring intensive care unit admission in Toronto, Canada. Clin Microbiol Infect. 2009;15:S26. Google Scholar3. Liem NT, Tung CV, Hien ND, Hien TT, Chau NQ, Long HT, et al. Clinical features of human influenza A (H5N1) infection in Vietnam: 2004-2006. Clin Infect Dis. 2009;48:1639-46. [PMID: 19435433] CrossrefMedlineGoogle Scholar4. Hanshaoworakul W, Simmerman JM, Narueponjirakul U, Sanasuttipun W, Shinde V, Kaewchana S, et al. Severe human influenza infections in Thailand: oseltamivir treatment and risk factors for fatal outcome. PLoS One. 2009;4:6051. [PMID: 19557130] CrossrefMedlineGoogle Scholar5. Laupacis A, Mamdani M. Observational studies of treatment effectiveness: some cautions [Editorial]. Ann Intern Med. 2004;140:923-4. [PMID: 15172907] LinkGoogle Scholar6. Beyersmann J, Gastmeier P, Wolkewitz M, Schumacher M. An easy mathematical proof showed that time-dependent bias inevitably leads to biased effect estimation. J Clin Epidemiol. 2008;61:1216-21. [PMID: 18619803] CrossrefMedlineGoogle Scholar7. Hama R, Jones M, Okushima H, Kitao M, Noda N, Hayashi K, et al. Oseltamivir and early deterioration leading to death: a proportional mortality study for 2009A/H1N1 influenza. Int J Risk Saf Med. 2011;23:201-15. [PMID: 22156085] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Queensland School of Population Health, Brisbane, Queensland 4006, Australia.Disclosures: Dr. Jones: Other: unpaid investigator on a UK National Institute for Health Research grant for a systematic review of neuraminidase inhibitors. Dr. Hama: Expert testimony (unpaid): provided scientific opinions on 11 adverse reaction cases related to oseltamivir following application by families for adverse reaction compensation; however, received no money for 8 cases and during the 82 months prior to submission; Royalties: books published by Kin-yobi Co Ltd and Japan Institute of Pharmacovigilence; Other: paid investigator on a UK National Institute for Health Research grant for a systematic review of neuraminidase inhibitors. Dr. Del Mar: Consultancy: Key Pharmaceuticals (topical ear product), GlaxoSmithKline (vaccine for otitis media); Grants/grants pending (money to institution): National Health and Medical Research Council (Australia), UK National Institute for Health Research; Royalties: books published by Elsevier and BMJ; Travel/accommodations/meeting expenses unrelated to activities listed: travel to Taiwan for an international conference on viral illness in March 2010; Other: Coordinating Editor of the Acute Respiratory Infections Group of the Cochrane Collaboration. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAntivirals for Treatment of Influenza Jonathan Hsu , Nancy Santesso , Reem Mustafa , Jan Brozek , Yao Long Chen , Jessica P. Hopkins , Adrienne Cheung , Gayane Hovhannisyan , Liudmila Ivanova , Signe A. Flottorp , Ingvil Sæterdal , Arthur D. Wong , Jinhui Tian , Timothy M. Uyeki , Elie A. Akl , Pablo Alonso-Coello , Fiona Smaill , and Holger J. Schünemann Antivirals for Treatment of Influenza Carl Heneghan , Tom Jefferson , and Peter Doshi Antivirals for Treatment of Influenza Holger J. Schünemann , Nancy Santesso , Jan Brozek , and Metrics 4 September 2012Volume 157, Issue 5Page: 385KeywordsAdverse reactionsAntiviralsNeuraminidase inhibitorsObservational studiesRegression analysisResearch grantsSurvival analysisSystematic reviewsVaccines ePublished: 4 September 2012 Issue Published: 4 September 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...