Efficacy of oseltamivir compared with zanamivir in COPD patients with seasonal influenza virus infection: a randomized controlled trial

Abstract

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P40.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.

Isoforskolin Alleviates AECOPD by Improving Pulmonary Function and Attenuating Inflammation Which Involves Downregulation of Th17/IL-17A and NF-κB/NLRP3

“…PDN and OSE were used as positive drugs in the study, considering that systemic corticosteroids are efficacious for AECOPD treatment in clinic and OSE is effective in influenza virus-infected COPD patients (Li et al, 2020;Whittaker Brown and Braman, 2020). As a powerful anti-inflammatory drug, PDN significantly ameliorated the key features in AECOPD model mice.…”

“…Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow obstruction, and it is currently the third largest cause of human mortality worldwide (Rabe and Watz, 2017;Collaborators, 2020;Whittaker Brown and Braman, 2020). Acute exacerbation of COPD (AECOPD), defined as "an acute worsening of respiratory symptoms that result in additional therapy," is the main cause of high hospitalization rates and mortality in COPD patients (Collaborators, 2020;Li et al, 2020;Whittaker Brown and Braman, 2020). The major risk factor of COPD is cigarette smoke (CS), and viral or bacterial respiratory infections result in COPD exacerbations with increased airway inflammation and mucus secretion (Whittaker Brown and Braman, 2020;MacLeod et al, 2021).…”

“…According to the guidelines of Global Initiative for Chronic Obstructive Lung Disease (GOLD), long-acting β2-adrenoceptor agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and inhaled corticosteroids (ICSs) were recommended to treat COPD patients with severe symptoms and/or high risk exacerbation history (Collaborators, 2020). Additionally, phosphodiesterase-4 inhibitor, antibiotics, or antiviral drugs could be beneficial for specific subsets of AECOPD patients (Li et al, 2020;Whittaker Brown and Braman, 2020;MacLeod et al, 2021). Despite the progress in symptom treatment and prevention of exacerbations, it is still challenging to develop novel treatments to ameliorate disease progression or affect mortality (Rabe and Watz, 2017;Whittaker Brown and Braman, 2020).…”

Penggunaan Antivirus untuk COVID-19

“…31 Pemberian oseltamivir pada pasien influenza dan penyakit paru obstruktif kronik efektif menurunkan suhu tubuh dan meningkatkan perbaikan klinis dibandingkan zanamivir (97,5% vs 83,8%). 32 Oseltamivir merupakan salah satu antivirus yang direkomendasikan oleh Pedoman Tatalaksana COVID-19 Edisi 3 Indonesia sebagai terapi COVID-19 derajat ringan. 4 Oseltamivir dinilai dapat menurunkan risiko kematian pada pasien gejala berat, namun tidak memperlambat progresivitas COVID-19.…”