Antivirals for Treatment of Influenza
Authors: Carl Heneghan, Tom Jefferson, Peter Doshi
Journal: Annals of Internal Medicine (2012)

Letters4 September 2012Antivirals for Treatment of InfluenzaCarl Heneghan, DPhil, Tom Jefferson, MD, and Peter Doshi, PhDCarl Heneghan, DPhilFrom University of Oxford, Oxford OX1 2ET, United Kingdom; The Cochrane Collaboration, Rome 00187, Italy; and Johns Hopkins University, Baltimore, MD 21211.Search for more papers by this author, Tom Jefferson, MDFrom University of Oxford, Oxford OX1 2ET, United Kingdom; The Cochrane Collaboration, Rome 00187, Italy; and Johns Hopkins University, Baltimore, MD 21211.Search for more papers by this author, and Peter Doshi, PhDFrom University of Oxford, Oxford OX1 2ET, United Kingdom; The Cochrane Collaboration, Rome 00187, Italy; and Johns Hopkins University, Baltimore, MD 21211.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-5-201209040-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We disagree with Hsu and colleagues' (1) presentation of results from their meta-analysis of observational studies. Properly reporting the results of meta-analyses of large data sets of poor-quality evidence is tricky. Large sample sizes alone will generate effect estimates with narrow CIs, but if the underlying data are of poor quality, there is no guarantee that these effect estimates are trustworthy. Hsu and colleagues graded their evidence as low- or very-low-quality, yet still presented statistically significant numerical results and concluded that oseltamivir “may reduce” mortality and hospitalization. This optimism is misplaced, for the “confounding and selection, reporting, ...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. Jefferson T, Jones MA, Doshi P, Del Mar CB, Heneghan CJ, Hama R, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2012;1:CD008965. [PMID: 22258996] MedlineGoogle Scholar3. Agency for Healthcare Research and Quality. Methods Guide for Comparative Effectiveness Reviews: Selecting Observational Studies for Comparing Medical Interventions. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/196/454/MethodsGuideNorris_06042010.pdf on 11 March 2012. Google Scholar4. Thomas RE, Jefferson TO, Demicheli V, Rivetti D. Influenza vaccination for health-care workers who work with elderly people in institutions: a systematic review. Lancet Infect Dis. 2006;6:273-9. [PMID: 16631547] CrossrefMedlineGoogle Scholar5. Jefferson T, Di Pietrantonj C, Debalini MG, Rivetti A, Demicheli V. Inactivated influenza vaccines: methods, policies, and politics. J Clin Epidemiol. 2009;62:677-86. [PMID: 19124222] CrossrefMedlineGoogle Scholar6. Uyeki T. 2011-2012 Influenza Season: Antiviral Medication Recommendations. Atlanta: Centers for Disease Control and Prevention; 2012. Accessed at www.bt.cdc.gov/coca/calls/2012/callinfo_022812.asp on 13 March 2012. Google Scholar Author, Article, and Disclosure InformationAuthors: Carl Heneghan, DPhil; Tom Jefferson, MD; Peter Doshi, PhDAffiliations: From University of Oxford, Oxford OX1 2ET, United Kingdom; The Cochrane Collaboration, Rome 00187, Italy; and Johns Hopkins University, Baltimore, MD 21211.Disclosures: Dr. Heneghan: Grant (money to institution): National Institute for Health Research; Other: evidence-based training workshops book royalties, expenses from the World Health Organization, and payment from The Guardian and Channel 4 television. Dr. Jefferson: Grants: National Institute for Health Research; Consultancy: market research organizations (unrelated to infectious diseases); Expert testimony: expert opinion on a lawsuit in Seattle, Washington; Royalties: books published on peer review, critical appraisal, health economics, and HTA; Payment for development of educational presentations: presentations on peer review, critical appraisal, health economics, and HTA. Dr. Doshi: Grants/grants pending: National Institute for Health Research for a Cochrane review of neuraminidase inhibitors. 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 Holger J. Schünemann , Nancy Santesso , Jan Brozek , and Antivirals for Treatment of Influenza Mark A. Jones , Rokuro Hama , and Chris Del Mar Metrics 4 September 2012Volume 157, Issue 5Page: 385-386KeywordsAntiviralsHealth economicsHospitalizationsObservational studiesOdds ratioPeer reviewResearch quality assessmentSystematic reviewsVaccines ePublished: 4 September 2012 Issue Published: 4 September 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...