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Review
. 2013 Feb 15;207(4):553-63.
doi: 10.1093/infdis/jis726. Epub 2012 Nov 29.

Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-2010 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients

Stella G Muthuri  1 , Puja R Myles, Sudhir Venkatesan, Jo Leonardi-Bee, Jonathan S Nguyen-Van-Tam
Affiliations
Review

Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-2010 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients

Stella G Muthuri et al. J Infect Dis. .

Abstract

Background: The impact of neuraminidase inhibitor (NAI) treatment on clinical outcomes of public health importance during the 2009-2010 pandemic has not been firmly established.

Methods: We conducted a systematic review and meta-analysis, searching 11 databases (2009 through April 2012) for relevant studies. We used standard methods conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random effects models.

Results: Regarding mortality we observed a nonsignificant reduction associated with NAI treatment (at any time) versus none (OR, 0.72 [95% CI, .51-1.01]). However we observed significant reductions for early treatment (≤48 hours after symptom onset) versus late (OR, 0.38 [95% CI, .27-.53]) and for early treatment versus none (OR, 0.35 [95% CI, .18-.71]). NAI treatment (at any time) versus none was associated with an elevated risk of severe outcome (OR, 1.76 [95% CI, 1.22-2.54]), but early versus late treatment reduced the likelihood (OR, 0.41 [95% CI, .30-.56]).

Conclusions: During the 2009-2010 influenza A(H1N1) pandemic, early initiation of NAI treatment reduced the likelihood of severe outcomes compared with late or no treatment.

Prospero registration: CRD42011001273.

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Figures

Figure 1.
Figure 1.
Summary of article selection process. Abbreviation: NAI, neuraminidase inhibitor.
Figure 2.
Figure 2.
Summary of pooled analyses from studies examining mortality. Abbreviations: CI, confidence interval; NAI, neuraminidase inhibitor; OR, odds ratio.
Figure 3.
Figure 3.
Summary of pooled analyses from studies examining severe outcome. Abbreviations: CI, confidence interval; NAI, neuraminidase inhibitor; OR, odds ratio.
Figure 4.
Figure 4.
Summary of pooled analyses from studies examining A(H1N1)pdm09-associated pneumonia. Abbreviations: CI, confidence interval; NAI, neuraminidase inhibitor; OR, odds ratio.
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