Safety and effectiveness of neuraminidase inhibitors for influenza treatment, prophylaxis, and outbreak control: a systematic review of systematic reviews and/or meta-analyses

J Antimicrob Chemother. 2017 Nov 1;72(11):2990-3007. doi: 10.1093/jac/dkx271.

Abstract

Objectives: To review evidence from systematic reviews and/or meta-analyses (SR/MAs) regarding neuraminidase inhibitor (NI) safety and effectiveness.

Methods: We conducted an SR of SR/MAs of randomized control and/or observational studies. We searched eight electronic databases for SR/MAs that examined the effectiveness or safety of NIs administered for influenza (i.e. influenza-like illness or lab-confirmed) treatment or prophylaxis.

Results: We identified 27 (0.7%) eligible SR/MAs of 3723 articles reviewed. NI (n = 2) or oseltamivir (n = 1) versus no treatment were consistently associated with a decrease in mortality odds among the hospitalized, general population (OR range 0.2 - 0.8). Oseltamivir versus no treatment was associated with a decrease in hospitalization and pneumonia risk/odds in 2/4 SR/MAs. Oseltamivir (n = 4) and zanamivir (n = 3) were consistently associated with a 0.5 - 1 day decrease in symptom duration. Oseltamivir (n = 4) or zanamivir (n = 4) versus no prophylaxis were consistently associated with a decrease in the odds/risk of symptomatic secondary transmission (OR/RR range 0.1 - 0.5). Oseltamivir versus no treatment was consistently associated with a 1.5- to 2.5-fold increase in the odds/risk of nausea (n = 4) and vomiting (n = 5).

Conclusions: NI treatment is likely to be effective at reducing mortality among hospitalized patients, and symptom duration by up to 1 day in the general population. Oseltamivir or zanamivir prophylaxis are likely to be effective at reducing secondary symptomatic influenza transmission. Increased nausea and vomiting are likely associated with oseltamivir use. We recommend that decisions regarding NI use are made in consideration of potential adverse events, particularly for the general population at low risk of complications. Among hospitalized patients, NI administration seems warranted to reduce mortality risk.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antiviral Agents / administration & dosage
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Disease Outbreaks / prevention & control*
  • Enzyme Inhibitors / administration & dosage
  • Enzyme Inhibitors / adverse effects
  • Enzyme Inhibitors / therapeutic use*
  • Hospitalization
  • Humans
  • Influenza, Human / drug therapy*
  • Influenza, Human / mortality
  • Influenza, Human / prevention & control*
  • Influenza, Human / virology
  • Neuraminidase / antagonists & inhibitors*
  • Oseltamivir / administration & dosage
  • Oseltamivir / adverse effects
  • Oseltamivir / therapeutic use
  • Pneumonia / drug therapy
  • Pneumonia / prevention & control
  • Pneumonia / virology
  • Zanamivir / administration & dosage
  • Zanamivir / adverse effects
  • Zanamivir / therapeutic use

Substances

  • Antiviral Agents
  • Enzyme Inhibitors
  • Oseltamivir
  • Neuraminidase
  • Zanamivir