Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis

Publication

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis

Journal Paper/Review - Feb 1, 2016

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

Citation

Kusznierz G, McGeer A, Memish Z, Metan G, Mikić D, Mohn K, Moradi A, Nymadawa P, Ozbay B, Mayo-Montero E, Manabe T, Madanat F, Kuzman I, Kwan A, Lahlou Amine I, Langenegger E, Lankarani K, Leo Y, Linko R, Liu P, Ozkan M, Parekh D, Tran D, Uyeki T, van Zwol A, Vaudry W, Velyvyte D, Vidmar T, Zarogoulidis P, Törün S, Torres A, Tang J, Paul M, Poeppl W, Polack F, Rath B, Rodríguez A, Siqueira M, Skręt-Magierło J, Talarek E, Nguyen-Van-Tam J, Knight M, Muthuri S, Bassetti M, Beovic B, Bingisser R, Bonmarin I, Borja-Aburto V, Cao B, Carratala J, Cuezzo M, Barhoush M, Bantar C, Báez C, Venkatesan S, Myles P, Leonardi-Bee J, Lim W, Al Mamun A, Anovadiya A, Araújo W, Azziz-Baumgartner E, Denholm J, Dominguez S, Hoeger P, Hoffmann M, Hu X, Islam Q, Jiménez M, Kandeel A, Keijzers G, Khalili H, Higuera Iglesias A, Herberg J, Gubbels S, Duarte P, Dubnov-Raz G, Echavarria M, Fanella S, Fraser J, Gao Z, Gérardin P, Giannella M, Khandaker G. Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis. Influenza Other Respir Viruses 2016; 10:192-204.

Type

Journal Paper/Review (English)

Journal

Influenza Other Respir Viruses 2016; 10

Publication Date

Feb 1, 2016

Issn Electronic

1750-2659

Pages

192-204

Brief description/objective

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.