Treatment of influenza with neuraminidase inhibitors

Abstract

Purpose of review: Seasonal and pandemic influenza are major causes of morbidity and mortality globally. Neuraminidase inhibitors (NAIs) are the only class of antiviral agent recommended for the treatment of currently circulating strains of influenza. There has previously been controversy over the level of evidence for patient benefit with NAIs. We review here the current evidence base for the clinical impact of treatment of influenza with NAIs. Recent findings: Meta-analysis of pharma sponsored studies (including previously unpublished data) shows that NAIs reduce the duration of illness in influenza infected patients, and suggest a possible reduction in the rate of complications and hospitalisation. Meta-analysis of observational studies examining oseltamivir use during the H1N1 2009 pandemic, suggest a reduction in hospitalisation rate in community dwelling patients and a reduction in mortality in hospitalised adults treated with NAIs. Current NAI use in the community and hospitals varies widely but in general they are underutilised. Summary: Although there has been controversy over the level of evidence for patient benefit, a growing body of evidence suggests that treatment of influenza with NAIs is associated with improved outcomes for both patients in the community and more severely unwell patients in hospital. Clinical outcomes are optimal with earlier use and strategies to improve early widespread NAI utilisation are needed.

Influenza-associated mortality in hospital care: a retrospective cohort study of risk factors and impact of oseltamivir in an English teaching hospital, 2016 to 2017

“…However, these trials have been done in outpatients and almost exclusively in younger adults with no comorbidities and are probably not generalisable to the largely elderly hospitalised population in this study [9,39] for whom oseltamivir treatment is recommended by NICE, IDSA, CDC and WHO [16,18,19,22,40]. Our findings concur with meta-analyses of observational studies concluding a protective effect of oseltamivir on mortality in patients hospitalised with Influenza [41,42]. However, Jones and Wolkewitz have raised concerns about the meta-analysis by Muthuri et al on handling of time-dependent treatment and the absence of follow up beyond hospital discharge [43,44].…”

In Vitro Combinations of Baloxavir Acid and Other Inhibitors against Seasonal Influenza A Viruses

“…Antivirals are recommended for the treatment of seasonal influenza viruses, especially in high risk populations (elderly, immunocompromised patients and subjects with co-morbidities) [ 8 ]. Neuraminidase inhibitors (NAIs), such as oseltamivir, zanamivir, peramivir and lanamivir, constitute the main recommended drugs for the treatment of influenza viruses in many countries [ 9 , 10 , 11 ]. These drugs inhibit the neuraminidase (a glycoprotein that enables the virus to be released from host cell) which reduces clinical illness [ 9 , 12 ].…”

“…Neuraminidase inhibitors (NAIs), such as oseltamivir, zanamivir, peramivir and lanamivir, constitute the main recommended drugs for the treatment of influenza viruses in many countries [ 9 , 10 , 11 ]. These drugs inhibit the neuraminidase (a glycoprotein that enables the virus to be released from host cell) which reduces clinical illness [ 9 , 12 ]. In addition to this major class of antivirals, RNA-dependent RNA polymerase (RdRp) inhibitors are also approved in a few countries to treat influenza A and B viruses.…”

Seasonal and pandemic influenza: 100 years of progress, still much to learn

“…More usually, cases are seen on day 4 or beyond, at which time antivirals may have a relatively small effect. 66,67 WHO guidelines recommend antiviral treatment in uncomplicated influenza in those with risk factors for complicated illness, as well as treatment of patients with severe or progressive clinical presentations of suspected or confirmed influenza. 68 Neuraminidase inhibitors (NAIs) are most often used; although adamantanes (amantadine and rimantadine) and ribavirin have activity against some influenza viruses, their use is limited by side-effects and antiviral resistance.…”