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Meta-Analysis
. 2016 May;10(3):192-204.
doi: 10.1111/irv.12363. Epub 2016 Feb 1.

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

Stella G Muthuri  1 , Sudhir Venkatesan  1 , Puja R Myles  1 , Jo Leonardi-Bee  1 , Wei Shen Lim  2 , Abdullah Al Mamun  3 , Ashish P Anovadiya  4 , Wildo N Araújo  5 , Eduardo Azziz-Baumgartner  6 , Clarisa Báez  7 , Carlos Bantar  8 , Mazen M Barhoush  9 , Matteo Bassetti  10 , Bojana Beovic  11 , Roland Bingisser  12 , Isabelle Bonmarin  13 , Victor H Borja-Aburto  14 , Bin Cao  15 , Jordi Carratala  16 , María R Cuezzo  17 , Justin T Denholm  18 , Samuel R Dominguez  19 , Pericles A D Duarte  20 , Gal Dubnov-Raz  21 , Marcela Echavarria  22 , Sergio Fanella  23 , James Fraser  24 , Zhancheng Gao  25 , Patrick Gérardin  26   27   28   29 , Maddalena Giannella  30 , Sophie Gubbels  31 , Jethro Herberg  32 , Anjarath L Higuera Iglesias  33 , Peter H Hoeger  34 , Matthias Hoffmann  35 , Xiaoyun Hu  36 , Quazi T Islam  37 , Mirela F Jiménez  38 , Amr Kandeel  39 , Gerben Keijzers  40 , Hossein Khalili  41 , Gulam Khandaker  42 , Marian Knight  43 , Gabriela Kusznierz  44 , Ilija Kuzman  45 , Arthur M C Kwan  46 , Idriss Lahlou Amine  47 , Eduard Langenegger  48 , Kamran B Lankarani  49 , Yee-Sin Leo  50 , Rita Linko  51 , Pei Liu  52 , Faris Madanat  53 , Toshie Manabe  54 , Elga Mayo-Montero  55 , Allison McGeer  56 , Ziad A Memish  57   58 , Gokhan Metan  59 , Dragan Mikić  60 , Kristin G I Mohn  61   62 , Ahmadreza Moradi  63   64 , Pagbajabyn Nymadawa  65 , Bulent Ozbay  66 , Mehpare Ozkan  67 , Dhruv Parekh  68 , Mical Paul  69 , Wolfgang Poeppl  70 , Fernando P Polack  71   72 , Barbara A Rath  73 , Alejandro H Rodríguez  74 , Marilda M Siqueira  75 , Joanna Skręt-Magierło  76 , Ewa Talarek  77 , Julian W Tang  78   79   80 , Antoni Torres  81 , Selda H Törün  82 , Dat Tran  83 , Timothy M Uyeki  84 , Annelies van Zwol  85 , Wendy Vaudry  86 , Daiva Velyvyte  87 , Tjasa Vidmar  88 , Paul Zarogoulidis  89 ; PRIDE Consortium Investigators; Jonathan S Nguyen-Van-Tam  1
Collaborators, Affiliations
Meta-Analysis

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

Stella G Muthuri et al. Influenza Other Respir Viruses. 2016 May.

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: Hospitalisation; individual participant data meta-analyses; influenza-related pneumonia; neuraminidase inhibitors.

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Figures

Figure 1
Figure 1
Study flow diagram. *Two hundred and sixty patients added since publication of Muthuri et al.17 following clarification of inpatient status from data collaborator.
Figure 2
Figure 2
Summary of main findings for influenza‐related pneumonia (IRP) in laboratory‐ and clinical diagnosed influenza patients, all ages.
See this image and copyright information in PMC

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