Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high‐risk populations: A systematic review and meta‐analysis

Abstract

Background Oseltamivir is recommended in the treatment of influenza illness in high‐risk populations, including those with chronic heart and lung diseases. Objectives We conducted a systematic review and meta‐analysis to determine the rate of use and effectiveness of oseltamivir in these groups of patients. Methods The protocol for the systematic review was registered on PROSPERO (CRD42019125998). Medline, EMBASE, Cochrane CENTRAL, and CINAHL were searched for observational studies and randomized controlled trials published up to 16 February 2020. Quality appraisal of final studies was conducted using GRADE guidelines. Data were extracted using a predeveloped template. Main outcomes measured included the rate of use of oseltamivir for influenza‐like‐illness and its effectiveness in reducing disease severity in patients with cardiopulmonary diseases. Outcomes measured for effectiveness were influenza‐related complications (respiratory infections and asthma exacerbations), hospitalization rates, and time to freedom from illness. Risk of bias was assessed using Cochrane's Risk of Bias 2.0 tool for randomized trials and Cochrane's Risk of Bias in nonrandomized Studies of Interventions tool for nonrandomized trials. Where data were available, pooled analyses were conducted. Dichotomous variables were evaluated using the Mantel‐Hansel method. A random effect model was applied. Summary measures were reported as risk ratios where relevant. Results Our systematic review identified nine studies. Oseltamivir use ranged from 25% to 100%. When oseltamivir group was compared to placebo, rates of respiratory tract infections reduced by 28% (RR = 0.72, 95% CI = 0.59‐0.90), hospitalization reduced by 52% (RR = 0.48, 95% CI = 0.28‐0.80) and median time to illness alleviation decreased by 10.4 to 120 hours. There was no significant reduction in asthma exacerbation rates. Conclusions Our systematic review suggests that the use of oseltamivir is beneficial in reducing disease severity, however, its use in high‐risk population remains suboptimal.

Antivirals for treatment of non-severe influenza: a systematic review and network meta-analysis of randomized controlled trials

“…8,10 Previous pairwise meta-analyses, including no more than nine studies, have evaluated the effects of oseltamivir on influenza and reported that, compared to standard care or placebo, oseltamivir might reduce hospitalization. 18,44 The results differed from our findings mainly because the previous meta-analyses only included studies published before 2014. Another more recent meta-analysis including 12 studies with 6295 outpatients patients reported that oseltamivir may not be associated with reduced risk of hospitalization and may associated with increased nausea and vomiting.…”

Risk factors for infection with influenza A(H3N2) virus on a US university campus, October–November 2021

“…Higher treatment rates (e.g., 20%-40%) have been recorded in studies of special populations, such as hospitalized patients, older adults in residential care settings, and children with chronic medical conditions. 19,20 Antiviral treatment among university students may represent an avenue for additional intervention given recommendations to consider using influenza antivirals for postexposure prophylaxis to prevent infection in communal settings (e.g., shelters, university dormitories, and prisons) and reduce strain on healthcare services in these settings during influenza outbreaks. 21 Our findings are subject to at least five limitations.…”

“…Although more than half of respondents reported contact with someone with ARI during the week before their clinic visit and almost a third reported specifically having a residential contact with ARI, only 7% reported being prescribed oseltamivir after presenting for testing. Higher treatment rates (e.g., 20%–40%) have been recorded in studies of special populations, such as hospitalized patients, older adults in residential care settings, and children with chronic medical conditions 19,20 . Antiviral treatment among university students may represent an avenue for additional intervention given recommendations to consider using influenza antivirals for post‐exposure prophylaxis to prevent infection in communal settings (e.g., shelters, university dormitories, and prisons) and reduce strain on healthcare services in these settings during influenza outbreaks 21…”

Management of Severe Influenza

“…77,78 A recent meta-analysis has shown that early treatment with oseltamivir is effective in reducing the severity of influenza illness in people with chronic cardio-respiratory disease. 79 There is a paucity of RCT evidence regarding the effect of oseltamivir in ICU patients admitted with severe influenza. In the absence of strong evidence from RCTs involving critically ill patients, observational studies have been relied upon to inform treatment recommendations in severe influenza.…”

“…77 78 A recent meta-analysis has shown that early treatment with oseltamivir is effective in reducing the severity of influenza illness in people with chronic cardio-respiratory disease. 79…”