Use of Oseltamivir After Influenza Infection Is Associated With Reduced Incidence of Recurrent Adverse Cardiovascular Outcomes Among Military Health System Beneficiaries With Prior Cardiovascular Diseases

Abstract

Background— Influenza infection has been associated with increased risk of adverse cardiac and cerebral vascular outcomes. Oseltamivir, a treatment for influenza, has been shown to decrease the severity of an influenza episode, but few data exist regarding its potentially protective effect against recurrent vascular outcomes among influenza patients with a history of vascular disease. Methods and Results— Electronic healthcare service and pharmacy records for 37 482 TRICARE beneficiaries, aged 18 and older, with a coded history of cardiovascular (CV) disease and a subsequent diagnosis of influenza from October 1, 2003, through September 30, 2007, were examined. Subjects were grouped according to whether they had filled a prescription for oseltamivir within 2 days of their influenza diagnosis. The incidence of recurrent CV events within 30 days after the influenza diagnosis among oseltavmivir-treated and untreated subjects was 8.5% and 21.2%, respectively ( P <0.005). Subject age was a persistent and significant contributor to the likelihood of recurrent CV outcomes. After controlling for the differences in demographics among treated and untreated cohorts using a propensity-scored logistic regression model, a statistically significant protective effect was associated with oseltamivir treatment (odds ratio, 0.417; 95% CI, 0.349 to 0.498). Conclusions— Our findings suggests that oseltamivir treatment for influenza is associated with significant decrease in the risk of recurrent CV events in subjects with a history of CV disease. These findings merit confirmation in further prospective and controlled studies. Meanwhile, in patients with CV disease, strict adherence with current practice guidelines for prevention and treatment of influenza is recommended.

Safety and pharmacokinetics of oseltamivir at standard and high dosages

“…A recent report has drawn attention to the association between influenza infection itself and adverse cardiac and cerebrovascular outcomes [13]. Retrospective data from 37 482 enrollees in a large US managed health programme have shown a marked protective effect of oseltamivir on patients with a history of cardiovascular disease who contract influenza.…”

Oseltamivir: the real world data

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] These studies fell naturally into two types: those based on large scale medical records or insurance claims based databases 10-13 16 17 21 25 and those based on tailored disease registries, 9 14 15 18 19 22-24 26 with the largest study including more than 80 000 subjects and the smallest studies including fewer than 300 subjects.…”

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

“…134 In the second report, two women treated with oseltamivir for suspected pandemic (H1N1) 2009 influenza developed bradycardia. 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, …”