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Observational Study
. 2025 Aug 1;81(1):190-197.
doi: 10.1093/cid/ciae584.

Benefit of Early Oseltamivir Therapy for Adults Hospitalized With Influenza A: An Observational Study

Nathaniel M Lewis  1 , Elizabeth J Harker  1 , Lauren B Grant  1 , Yuwei Zhu  2 , Carlos G Grijalva  2 , James D Chappell  2 , Jillian P Rhoads  2 , Adrienne Baughman  2 , Jonathan D Casey  2 , Paul W Blair  2 , Ian D Jones  2 , Cassandra A Johnson  2 , Adam S Lauring  3 , Manju Gaglani  4   5 , Shekhar Ghamande  5 , Cristie Columbus  5   6 , Jay S Steingrub  7 , Nathan I Shapiro  8 , Abhijit Duggal  9 , Laurence W Busse  10 , Jamie Felzer  10 , Matthew E Prekker  11 , Ithan D Peltan  12   13 , Samuel M Brown  12   13 , David N Hager  14 , Michelle N Gong  15 , Amira Mohamed  15 , Matthew C Exline  16 , Akram Khan  17 , Catherine L Hough  17 , Jennifer G Wilson  18 , Jarrod Mosier  19 , Nida Qadir  20 , Steven Y Chang  20 , Adit A Ginde  21 , Amanda Martinez  21 , Nicholas M Mohr  22 , Christopher Mallow  23 , Estelle S Harris  12 , Nicholas J Johnson  24 , Vasisht Srinivasan  24 , Kevin W Gibbs  25 , Jennie H Kwon  26 , Ivana A Vaughn  27 , Mayur Ramesh  28 , Basmah Safdar  29 , Anirudh Goyal  29 , Lauren E DeLamielleure  29 , Jennifer DeCuir  30 , Diya Surie  30 , Fatimah S Dawood  30 , Mark W Tenforde  1 , Timothy M Uyeki  1 , Shikha Garg  1 , Sascha Ellington  1 , Wesley H Self  2 ; Investigating Respiratory Viruses in the Acutely Ill (IVY) Network
Collaborators, Affiliations
Observational Study

Benefit of Early Oseltamivir Therapy for Adults Hospitalized With Influenza A: An Observational Study

Nathaniel M Lewis et al. Clin Infect Dis. .

Abstract

Background: Clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza.

Methods: A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during 1 October 2022-21 July 2023. A multivariable proportional odds model was used to compare peak pulmonary disease severity (no oxygen support, standard supplemental oxygen, high-flow oxygen/non-invasive ventilation, invasive mechanical ventilation, or death) after the day of hospital admission among patients starting oseltamivir treatment on the day of admission (early) versus those who did not (late or not treated), adjusting for baseline (admission day) severity, age, sex, site, and vaccination status. Multivariable logistic regression models were used to evaluate the odds of intensive care unit (ICU) admission, acute kidney replacement therapy or vasopressor use, and in-hospital death.

Results: A total of 840 influenza-positive patients were analyzed, including 415 (49%) who started oseltamivir treatment on the day of admission, and 425 (51%) who did not. Compared with late or not treated patients, those treated early had lower peak pulmonary disease severity (proportional adjusted odds ratio [aOR]: 0.60, 95% confidence interval [CI]: .49-.72), and lower odds of intensive care unit admission (aOR: 0.24, 95% CI: .13-.47), acute kidney replacement therapy or vasopressor use (aOR: 0.40, 95% CI: .22-.67), and in-hospital death (aOR: 0.36, 95% CI: .18-.72).

Conclusions: Among adults hospitalized with influenza, treatment with oseltamivir on day of hospital admission was associated reduced risk of disease progression, including pulmonary and extrapulmonary organ failure and death.

Keywords: antiviral therapy; influenza; influenza-associated outcomes; invasive mechanical ventilation; oseltamivir; severity.

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Conflict of interest statement

Potential conflicts of interest. M. G. reports funding from CDC for the US Flu VE Network and SYNERGY study, CDC-Abt Associates for RECOVER-PROTECT cohort studies, and CDC-Westat for the VISION study, outside the submitted work. M. N. G. reports receiving grants from National Heart, Lung, and Blood Institute (NHLBI) as a Heart Failure Adherence and Retention Trial (HART) co-investigator and ASP Steering Committee, support for attending the ATS meeting, participating on an advisory board for Novartis, Philips Healthcare, Regeneron, and Radiometer, and participating on a DSMB for clinical trials for Best, outside the submitted work. C. G. G. reports receiving fees for participation in an advisory board for Merck and received research support from National Institutes of Health (NIH), CDC, Food and Drug Administration (FDA), Agency for Healthcare Research and Quality (AHRQ), and SyneosHealth, outside the submitted work. A. S. L. reports research funding from National Institute of Allergy and Infectious Diseases (NIAID), CDC, Burroughs Wellcome Fund, Michigan Department of Health and Human Services, and research funding and consulting fees from Roche related to a clinical trial of baloxavir to prevent influenza virus transmission, outside the submitted work. I. D. P. reports support from the NIH (grant number R35GM151147), research funding unrelated to the present manuscript from NIH and Intermountain Research and Medical Foundation, payments related to service as an expert witness, and payments to his institution from Bluejay Diagnostics, Regeneron, and Janssen Pharmaceuticals, outside the submitted work. M. R. reports participating on an advisory board for Moderna, AstraZeneca, and Pfizer, outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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