Neuraminidase Inhibitors in Influenza Treatment and Prevention–Is It Time to Call It a Day?

Abstract

Stockpiling neuraminidase inhibitors (NAIs) such as oseltamivir and zanamivir is part of a global effort to be prepared for an influenza pandemic. However, the contribution of NAIs for the treatment and prevention of influenza and its complications is largely debatable due to constraints in the ability to control for confounders and to explore unobserved areas of the drug effects. For this study, we used a mathematical model of influenza infection which allowed transparent analyses. The model recreated the oseltamivir effects and indicated that: (i) the efficacy was limited by design, (ii) a 99% efficacy could be achieved by using high drug doses (however, taking high doses of drug 48 h post-infection could only yield a maximum of 1.6-day reduction in the time to symptom alleviation), and (iii) contributions of oseltamivir to epidemic control could be high, but were observed only in fragile settings. In a typical influenza infection, NAIs’ efficacy is inherently not high, and even if their efficacy is improved, the effect can be negligible in practice.

In-host Mathematical Modelling of COVID-19 in Humans

“…The race to develop the first vaccine to tackle COVID-19 has started with the first clinical trial just 60 days after the genetic sequence of the virus. Modelling work developed in this paper paves the way for future mathematical models of COVID-19 to reveal prophylactic and therapeutic interventions at multi-scale levels ( Almocera, Hernandez-Vargas, 2019 , Feng, Cen, Zhao, Velasco-Hernandez, 2015 , Feng, Velasco-Hernandez, Tapia-Santos, Leite, 2012 , Handel, Rohani, 2015 , Nguyen, Mikolajczyk, Hernandez-Vargas, 2018 , Parra-Rojas, Nguyen, Hernandez-Mejia, Hernandez-Vargas, 2018 ). Further insights into immunology and pathogenesis of SARS-CoV-2 will help to improve the outcome of this and future pandemics.…”

Drugs for Influenza Treatment: Is There Significant News?

“…However, the available data do not permit firm conclusions regarding the effect of NAIs on severe cases (26–28). Although administration of NAIs was associated with a reduction of mortality during the recent 2009 pandemic (29), the impact on the development of serious influenza complications, hospitalization and mortality was not definitively demonstrated.…”

In-host Modelling of COVID-19 in Humans

“…Interestingly, SARS-CoV-2 56 replication cycles may last longer than flu, about 10 days or more after the incubation period [4,20]. 57 Here, we contribute to the mathematical study of SARS-CoV-2 dynamics at within-host level based on 58 data presented by Wolfel et al [21]. 59…”

“…In a more technical aspect using only viral load on the target cell model to estimate parameters may 191 lead to identifiability problems [48][49][50][51] multi-scale levels [52][53][54][55][56][57]. Further insights into immunology and pathogenesis of SARS-CoV-2 will help 199 to improve the outcome of this and future pandemics.…”