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. 2013 Jan;7 Suppl 1(Suppl 1):14-24.
doi: 10.1111/irv.12048.

Neuraminidase inhibitors for influenza: a review and public health perspective in the aftermath of the 2009 pandemic

Charles R Beck  1 , Rachel Sokal, Nachiappan Arunachalam, Richard Puleston, Anna Cichowska, Anthony Kessel, Maria Zambon, Jonathan S Nguyen-Van-Tam; UK Antiviral Effectiveness Review Group
Collaborators, Affiliations

Neuraminidase inhibitors for influenza: a review and public health perspective in the aftermath of the 2009 pandemic

Charles R Beck et al. Influenza Other Respir Viruses. 2013 Jan.

Abstract

Objectives: The objectives of this study were to: (1) reflect on key stages in the discovery, development and pre-pandemic use of neuraminidase inhibitors (NAIs), (2) summarise the evidence of NAI effectiveness for treatment and prophylaxis of seasonal influenza prior to the 2009 pandemic, and (3) summarise the evidence base generated during the 2009 pandemic period.

Design: A rapid systematic review of evidence published to June 2010 was conducted where existing high-quality systematic reviews formed a baseline and were supplemented with data from other reviews, randomised controlled trials (RCTs) and observational studies.

Main outcome measures: Severity and duration of symptoms; rates of severe illness, complications and death following treatment for influenza or influenza-like illness; rates of influenza and influenza-like illness following long-term prophylaxis or post-exposure prophylaxis of household contacts.

Results: Prior to the 2009 pandemic, evidence from RCTs conducted in seasonal influenza epidemics indicated that NAIs used to treat laboratory-confirmed influenza in healthy adults reduced the duration of illness by one day. NAIs provide high levels of protective efficacy in adults when given long-term or in household-based post-exposure prophylaxis for seasonal influenza. Several 2009 pandemic period observational studies suggest that early treatment may reduce rates of hospitalisation and in-hospital mortality, but data from that period do not substantially increase the evidence base on prophylaxis, although they confirm effectiveness.

Conclusions: NAIs should be deployed during a future pandemic for either post-exposure prophylaxis or treatment depending on national policy considerations and logistics. The existing evidence base on effectiveness against severe outcomes requires supplementation.

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Conflict of interest statement

The University of Nottingham Health Protection and Influenza Research Group is currently in receipt of research funds from GSK. The group has recently accepted an unrestricted educational grant for influenza research from F. Hoffmann‐La Roche. Research on influenza funded by an unrestricted educational grant from Astra Zeneca is also underway. The aforementioned funding received from GSK, F. Hoffmann‐La Roche and Astra Zeneca did not support any aspect of this work. JSN‐V‐T has received funding to attend influenza‐related meetings, lecture and consultancy fees and research funding from several influenza antiviral drug and vaccine manufacturers. All forms of personal remuneration ceased in September 2010, but departmental funding for influenza‐related research from GlaxoSmithKline, F. Hoffmann‐La Roche and Astra‐Zeneca remains current. He is a former employee of SmithKline Beecham plc. (now GlaxoSmithKline), Roche Products Ltd and Aventis‐Pasteur MSD (now Sanofi‐Pasteur MSD), all prior to 2005, with no outstanding pecuniary interests by way of shareholdings, share options or accrued pension rights. NA holds ordinary shares in GlaxoSmithKline plc; RP is currently undertaking research that is part‐funded by GlaxoSmithKline plc; JE received a one‐off honorarium from GlaxoSmithKline plc in 2008. The Health Protection Agency receives funding from a variety of vaccine manufacturers (GSK, Novartis, Crucell, Baxter, CSL) for specialist analysis of pandemic influenza vaccine clinical trials. MZ has served as the co‐chair of the international expert Neuraminidase Inhibitor Susceptibility Network (NISN) group (1999–2010), comprising public health, academic and virology experts established to develop methodology and initiate global surveillance of antiviral resistance, and is a member of the WHO expert advisory group on antivirals. MZ is a member of the ISIRV Antiviral Group.

No other authors have declared potential conflicts.

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