The Influence of Oseltamivir Treatment on the Risk of Stroke after Influenza Infection

Abstract

Objectives: It was the aim of this study to examine the influence of the antiviral medication oseltamivir on stroke and transient ischemic attack (TIA) in adults diagnosed with influenza. Methods: This retrospective cohort study used medical and pharmaceutical claims data from May 2000 to September 2006 from an administrative claims database. Episodes of stroke/TIA in the 6 months after influenza in adults (aged ≥18 years) prescribed oseltamivir within 1 day before or 2 days after influenza diagnosis (oseltamivir cohort), and adults prescribed no antivirals (comparison cohort) were compared using multivariate analyses adjusted for demographic and clinical risk factors. Results: The oseltamivir cohort comprised 49,238 patients and the comparison cohort 102,692 patients. Oseltamivir was associated with a 28% reduction in risk of stroke/TIA in the 6 months after influenza [hazard ratio (HR) 0.72; 95% CI 0.62–0.82] and with significant reductions after 1 and 3 months. In patients <65 years of age, there was a 34% risk reduction with oseltamivir after 6 months (HR 0.66; 95% CI 0.56–0.77) and also significant reductions after 1 and 3 months. In those aged ≥65 years, there was a 51% reduction in risk after 1 month (HR 0.49; 95% CI 0.27–0.91). Conclusions: Prescription of oseltamivir for influenza is associated with a reduced risk of stroke/TIA.

Guidelines for the Primary Prevention of Stroke

“…660,661 A retrospective study found that treatment with an antiviral agent within 2 days of an influenza diagnosis was associated with a 28% reduction (HR, 0.72; 95% CI, 0.62 to 0.82) in risk of stroke or TIA over the ensuing 6 months. 662 One casecontrol study 663 and 1 cohort study 664 of influenza vaccination demonstrate a reduced risk for stroke associated with vaccination. A prospective study in Taiwan found that influenza vaccination of persons Ͼ65 years of age was associated with lower all-cause mortality, including a 65% reduction in stroke (HR, 0.35; 95% CI, 0.27 to 0.45).…”

Oseltamivir in seasonal, pandemic, and avian influenza: a comprehensive review of 10-years clinical experience

“…135 The results of a retrospective cohort study, however, suggest that the risk of recurrent adverse cardiovascular outcomes such as heart failure and sudden cardiac death in patients with existing cardiovascular disease is lower in those treated with oseltamivir than those not treated, 136 and a similar benefit has been shown with respect to stroke and transient ischemic attacks. 137 An expert review of data from preclinical and clinical studies, …”

Influenza and Other Acute Respiratory Infections: Current Principles and Treatment Practice

“…По результатам мониторинга заболеваемости и циркуляции респираторных вирусов в ряде стран выяв-лены случаи тяжелых респираторных заболеваний, вызванных вирусами, которые приобрели новые антиген-ные свойства в результате реассортации [23][24][25].…”

“…Ингибиторы нейраминидазы (Осельтамивир, Занами-вир) эффективны для лечения гриппа при назначении не позднее 48 ч от начала клинических симптомов заболева-ния, но не применяются для лечения других ОРВИ, т. к. обладают селективным действием только на нейрамини-дазу вируса гриппа [22][23][24][25][26]. В отношении Занамивира (Реленза) следует также отметить, что препарат не приго-ден для широкого использования в клинической практике, т. к. может применяться только в виде ингаляций, что неприемлемо для детей дошкольного возраста и пожилых пациентов.…”

“…Вирус гриппа A (H3N2) начал циркулировать среди людей с 1968 г., вызвав пандемию «гонконгского гриппа» [23,25]. Но с тех пор этот штамм много раз мутировал и уже в 2014 г., пройдя по Европе, особого вреда никому не нанес.…”