Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis

Stella G. Muthuri Sudhir Venkatesan Puja R. Myles Jo Leonardi-Bee Wei Shen Lim Abdullah Al Mamun Ashish P. Anovadiya Wildo N. Araújo Eduardo Azziz-Baumgartner Clarisa Báez Carlos Bantar Mazen M. Barhoush Matteo Bassetti 1 Bojana Beovic Roland Bingisser Isabelle Bonmarin 2 Victor H. Borja-Aburto Bin Cao 3 Jordi Carratala María R. Cuezzo Justin T. Denholm Samuel R. Dominguez Pericles A. D. Duarte Gal Dubnov-Raz Marcela Echavarria Sergio Fanella James Fraser 4 Zhancheng Gao 5 Patrick Gérardin 6 Maddalena Giannella Sophie Gubbels Jethro Herberg Anjarath L. Higuera Iglesias Peter H. Hoeger Matthias Hoffmann Xiaoyun Hu Quazi T. Islam Mirela F. Jiménez Amr Kandeel Gerben Keijzers Hossein Khalili Gulam Khandaker Marian Knight 7 Gabriela Kusznierz 8 Ilija Kuzman Arthur M. C. Kwan Idriss Lahlou Amine Eduard Langenegger Kamran B. Lankarani Yee-Sin Leo Rita Linko Pei Liu 9 Faris Madanat Toshie Manabe Elga Mayo-Montero Allison Mcgeer Ziad A. Memish Gokhan Metan Dragan Mikić Kristin G. I. Mohn Ahmadreza Moradi Pagbajabyn Nymadawa Bulent Ozbay Mehpare Ozkan Dhruv Parekh Mical Paul Wolfgang Poeppl Fernando P. Polack Barbara A. Rath Alejandro H. Rodríguez Marilda M. Siqueira Joanna Skręt-Magierło Ewa Talarek Julian W. Tang Antoni Torres Selda H. Törün Dat Tran Timothy M. Uyeki Annelies Zwol Wendy Vaudry Daiva Velyvyte Tjasa Vidmar Paul Zarogoulidis Jonathan S. Nguyen-Van-Tam
1 University Hospital "Santa Maria della Misericordia"
2 INVS - Institut de Veille Sanitaire
3 Beijing Chao-Yang Hospital
4 Department of physics, engineering physics and astronomy
5 Peking University People's Hospital
6 PIMIT - Processus Infectieux en Milieu Insulaire Tropical
7 National Perinatal Epidemiology Unit
8 INER - Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Santa Fe, Argentina
9 State Key Laboratory of Advanced Electromagnetic Engineering and Technology
Abstract : Background The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. Methods A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. Results Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. Conclusions Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
Keywords : Open Access neuraminidase inhibitors influenza-related pneumonia individual participant data meta-analyses Hospitalisation
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Stella G. Muthuri, Sudhir Venkatesan, Puja R. Myles, Jo Leonardi-Bee, Wei Shen Lim, et al.. Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: an individual participant data meta-analysis. Influenza and Other Respiratory Viruses, Wiley Open Access, 2016, 10 (3), pp.192--204. ⟨10.1111/irv.12363⟩. ⟨hal-01452880⟩

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