Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: an individual participant data meta-analysis - Archive ouverte HAL Access content directly
Journal Articles The Lancet Respiratory Medicine Year : 2014

Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: an individual participant data meta-analysis

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Stella G. Muthuri
  • Function : Author
Sudhir Venkatesan
  • Function : Author
Puja R. Myles
  • Function : Author
Jo Leonardi-Bee
  • Function : Author
Tarig S. A. Al Khuwaitir
  • Function : Author
Adbullah Al Mamun
  • Function : Author
Ashish P. Anovadiya
  • Function : Author
Eduardo Azziz-Baumgartner
  • Function : Author
Clarisa Báez
  • Function : Author
Matteo Bassetti
  • Function : Author
  • PersonId : 911731
Bojana Beovic
  • Function : Author
Barbara Bertisch
  • Function : Author
Isabelle Bonmarin
  • Function : Author
  • PersonId : 915162
Robert Booy
  • Function : Author
Victor H. Borja-Aburto
  • Function : Author
Heinz Burgmann
  • Function : Author
Jordi Carratala
  • Function : Author
Justin T. Denholm
  • Function : Author
Samuel R. Dominguez
  • Function : Author
Pericles A. D. Duarte
  • Function : Author
Gal Dubnov-Raz
  • Function : Author
Marcela Echavarria
  • Function : Author
Sergio Fanella
  • Function : Author
Maddalena Giannella
  • Function : Author
Sophie Gubbels
  • Function : Author
Jethro Herberg
  • Function : Author
Anjarath L. H. Iglesias
  • Function : Author
Peter H. Hoger
  • Function : Author
Xiaoyun Hu
  • Function : Author
Quazi T. Islam
  • Function : Author
Mirela F. Jiménez
  • Function : Author
Amr Kandeel
  • Function : Author
Gerben Keijzers
Hossein Khalili
  • Function : Author
Marian Knight
  • Function : Author
  • PersonId : 918336
Koichiro Kudo
  • Function : Author
Gabriela Kusznierz
  • Function : Author
Ilija Kuzman
  • Function : Author
Arthur M. C. Kwan
  • Function : Author
Idriss L. Amine
  • Function : Author
Eduard Langenegger
  • Function : Author
Kamran B. Lankarani
  • Function : Author
Yee-Sin Leo
  • Function : Author
Rita Linko
  • Function : Author
Pei Liu
  • Function : Author
Faris Madanat
  • Function : Author
Elga Mayo-Montero
  • Function : Author
Allison Mcgeer
  • Function : Author
Ziad Memish
  • Function : Author
Gokhan Metan
  • Function : Author
Auksė Mickiene
  • Function : Author
Dragan Mikić
  • Function : Author
Kristin G. I. Mohn
  • Function : Author
Ahmadreza Moradi
  • Function : Author
Pagbajabyn Nymadawa
  • Function : Author
Maria E. Oliva
  • Function : Author
Mehpare Ozkan
  • Function : Author
Dhruv Parekh
  • Function : Author
Mical Paul
  • Function : Author
Fernando P. Polack
  • Function : Author
Barbara A. Rath
  • Function : Author
Alejandro H. Rodríguez
  • Function : Author
Elena B. Sarrouf
  • Function : Author
Anna C. Seale
  • Function : Author
Bunyamin Sertogullarindan
  • Function : Author
Marilda M. Siqueira
  • Function : Author
Joanna Skręt-Magierło
  • Function : Author
Frank Stephan
  • Function : Author
  • PersonId : 844760
Ewa Talarek
  • Function : Author
Julian W. Tang
  • Function : Author
Kelvin K. W. To
  • Function : Author
Antoni Torres
  • Function : Author
Selda H. Törün
  • Function : Author
Dat Tran
  • Function : Author
Timothy M. Uyeki
  • Function : Author
Annelies van Zwol
  • Function : Author
Wendy Vaudry
  • Function : Author
Tjasa Vidmar
  • Function : Author
Renata T. C. Yokota
  • Function : Author
Paul Zarogoulidis
  • Function : Author
Jonathan S. Nguyen-Van-Tam
  • Function : Author

Abstract

Background: Neuraminidase inhibitors were widely used during the 2009–10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods: We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings: We included data for 29 234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70–0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41–0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37–0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18–1·28]; p<0·0001 for the increasing HR with each day's delay). Interpretation: We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection. Funding F Hoffmann-La Roche.
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hal-01274568 , version 1 (21-06-2018)

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Stella G. Muthuri, Sudhir Venkatesan, Puja R. Myles, Jo Leonardi-Bee, Tarig S. A. Al Khuwaitir, et al.. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: an individual participant data meta-analysis. The Lancet Respiratory Medicine, 2014, 2 (5), pp.395-404. ⟨10.1016/S2213-2600(14)70041-4⟩. ⟨hal-01274568⟩
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