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Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials.
BMJ. 2003 Jun 07; 326(7401):1235.BMJ

Abstract

OBJECTIVE

To review the clinical effectiveness of oseltamivir and zanamivir for the treatment and prevention of influenza A and B.

DESIGN

Systematic review and meta-analyses of randomised controlled trials.

DATA SOURCES

Published studies were retrieved from electronic bibliographic databases; supplementary data were obtained from the manufacturers.

SELECTION OF STUDIES

Randomised controlled, double blind trials that were published in English, had data available before 31 December 2001, evaluated treatment or prevention of naturally occurring influenza with zanamivir or oseltamivir (if given using the formulation and dosage licensed for clinical use), and reported at least one end point of relevance.

REVIEW METHODS

The main outcome measures were the median time to the alleviation of symptoms (for treatment trials) and number of flu episodes avoided (for prevention trials). Three population groups were defined: children aged 12 years and under; otherwise healthy individuals aged 12 to 65 years; and "high risk" individuals (those with certain chronic medical conditions or aged 65 years and older).

RESULTS

Seventeen treatment trials and seven prevention trials identified met the inclusion criteria. All trials included compared one of the drugs against placebo or standard care. Treatment of children, otherwise healthy individuals, and high risk populations with zanamivir reduced the median duration of symptoms in days respectively by 1.0 (95% confidence interval 0.5 to 1.5), 0.8 (0.3 to 1.3), and 0.9 (-0.1 to 1.9) for the intention to treat population. The corresponding results, in days, for oseltamivir were 0.9 (0.3 to 1.5), 0.9 (0.3 to 1.4), and 0.4 (-0.7 to 1.4). The effect of giving zanamivir and oseltamivir prophylactically resulted in a relative reduction of 70-90% in the odds of developing flu, depending on the strategy adopted and the population studied.

CONCLUSIONS

Evidence from randomised controlled trials consistently supports the view that both oseltamivir and zanamivir are clinically effective for treating and preventing flu. However, evidence is limited for the treatment of certain populations and for all prevention strategies.

Authors+Show Affiliations

Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP. njc21@le.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

12791735

Citation

Cooper, Nicola J., et al. "Effectiveness of Neuraminidase Inhibitors in Treatment and Prevention of Influenza a and B: Systematic Review and Meta-analyses of Randomised Controlled Trials." BMJ (Clinical Research Ed.), vol. 326, no. 7401, 2003, p. 1235.
Cooper NJ, Sutton AJ, Abrams KR, et al. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ. 2003;326(7401):1235.
Cooper, N. J., Sutton, A. J., Abrams, K. R., Wailoo, A., Turner, D., & Nicholson, K. G. (2003). Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ (Clinical Research Ed.), 326(7401), 1235.
Cooper NJ, et al. Effectiveness of Neuraminidase Inhibitors in Treatment and Prevention of Influenza a and B: Systematic Review and Meta-analyses of Randomised Controlled Trials. BMJ. 2003 Jun 7;326(7401):1235. PubMed PMID: 12791735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. AU - Cooper,Nicola J, AU - Sutton,Alexander J, AU - Abrams,Keith R, AU - Wailoo,Allan, AU - Turner,David, AU - Nicholson,Karl G, PY - 2003/6/7/pubmed PY - 2003/7/2/medline PY - 2003/6/7/entrez SP - 1235 EP - 1235 JF - BMJ (Clinical research ed.) JO - BMJ VL - 326 IS - 7401 N2 - OBJECTIVE: To review the clinical effectiveness of oseltamivir and zanamivir for the treatment and prevention of influenza A and B. DESIGN: Systematic review and meta-analyses of randomised controlled trials. DATA SOURCES: Published studies were retrieved from electronic bibliographic databases; supplementary data were obtained from the manufacturers. SELECTION OF STUDIES: Randomised controlled, double blind trials that were published in English, had data available before 31 December 2001, evaluated treatment or prevention of naturally occurring influenza with zanamivir or oseltamivir (if given using the formulation and dosage licensed for clinical use), and reported at least one end point of relevance. REVIEW METHODS: The main outcome measures were the median time to the alleviation of symptoms (for treatment trials) and number of flu episodes avoided (for prevention trials). Three population groups were defined: children aged 12 years and under; otherwise healthy individuals aged 12 to 65 years; and "high risk" individuals (those with certain chronic medical conditions or aged 65 years and older). RESULTS: Seventeen treatment trials and seven prevention trials identified met the inclusion criteria. All trials included compared one of the drugs against placebo or standard care. Treatment of children, otherwise healthy individuals, and high risk populations with zanamivir reduced the median duration of symptoms in days respectively by 1.0 (95% confidence interval 0.5 to 1.5), 0.8 (0.3 to 1.3), and 0.9 (-0.1 to 1.9) for the intention to treat population. The corresponding results, in days, for oseltamivir were 0.9 (0.3 to 1.5), 0.9 (0.3 to 1.4), and 0.4 (-0.7 to 1.4). The effect of giving zanamivir and oseltamivir prophylactically resulted in a relative reduction of 70-90% in the odds of developing flu, depending on the strategy adopted and the population studied. CONCLUSIONS: Evidence from randomised controlled trials consistently supports the view that both oseltamivir and zanamivir are clinically effective for treating and preventing flu. However, evidence is limited for the treatment of certain populations and for all prevention strategies. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/12791735/Effectiveness_of_neuraminidase_inhibitors_in_treatment_and_prevention_of_influenza_A_and_B:_systematic_review_and_meta_analyses_of_randomised_controlled_trials_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=12791735 DB - PRIME DP - Unbound Medicine ER -