Publication

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

Journal Paper/Review - Feb 1, 2016

Units
PubMed
Doi

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.