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Internet memes can become powerful and persuasive, but they aren’t always true. The frenzied attacks on vaccines in general and the 2009 H1N1 vaccine in particular – which opponents literally called `deadlier than the virus’ – continue to this day, but are totally lacking in veracity (see The Monsters Are Due On Vaccine Street).
Another popular meme has been the demonization of Tamiflu ® (a neuraminidase inhibitor) as either useless and a huge waste of money, or dangerous (see Daily Mail: Ministers blew £650MILLION on useless anti-flu drugs).
Fueling this hysteria have been repeated Cochrane group analyses that have found insufficient evidence that the drug reduces influenza complications in healthy adults, although they limit their analyses to RCTs (Randomized Controlled Trials) of which few exist for this drug.
Observational studies – of which there are many supporting its use – were not included (see Revisiting Tamiflu Efficacy (Again)).
Much of the ire surrounding this drug has been garnered through Roche’s long-standing resistance to releasing all of their testing data, and that has led to critical editorials in the BMJ, and frequent excoriation in the British press.
As a result, many people have come away with the erroneous impression that these drugs are worthless – or worse.
We’ve seen a push back by the CDC (see The CDC Responds To The Cochrane Tamiflu Study ) and the UK’s PHE (see Revisiting Influenza Antiviral Recommendations), and last January we saw a meta-analysis in The Lancet that supported its use (see CIDRAP News On The Lancet Oseltamivir (Tamiflu ®) Meta-Analysis).
Still the level of mistrust and misinformation surrounding these types of antiviral drugs runs high, and so the CDC – in conjunction with MedScape - has released an 8 minute Expert Commentary – primarily for clinicians - on their proper use by Dr. Alicia Fry.
Although produced in late April, this video was only posted on the CDC’s Flu website in the past week.
Neuraminidase Inhibitors: Ready and Able to Tackle the Flu
Alicia Fry, MD, MPH
Despite a lack of RCTs, there are studies that show that Tamiflu can significantly reduce morbidity and mortality associated with influenza – particularly with severe, or novel infections. Some we’ve looked at in the past include:
- In 2010 we saw an observational study that appeared in JAMA (see Study: Antivirals Saved Lives Of Pregnant Women) that strongly suggested that Tamiflu was life saving for some patients with pandemic flu.
- And again in 2010, in BMJ: Efficacy of Oseltamivir In Mild H1N1, we saw a study which suggested that the administration of oseltamivir may have significantly reduced the incidence of pneumonia among otherwise healthy pandemic H1N1 patients.
- In December of 2012, in Study: The Benefits Of Antiviral Therapy During the 2009 Pandemic we looked at a meta-analysis of 90 observational studies that appeared in the Journal of Infectious Diseases that spanned nearly 35,000 patients, 85% of whom has laboratory confirmed H1N1.
Their main finding was antiviral therapy - principally oseltamivir - initiated within 48 hours of onset, reduced the likelihood of severe outcomes, namely admission to a critical care unit or death, by 49 to 65%.
And even more impressively (and perhaps, more importantly with HPAI H5 viruses on the rise again), in 2010’s Study: Antiviral Therapy For H5N1, we saw the largest look to date at outcomes of H5N1 patients who either received, or did not receive, antiviral treatment.
- The research appears in the IDSA’s Journal of Infectious Diseases. The bottom line is essentially out of 308 cases studied, the overall survival rate was a dismal 43.5%.
- But . . . of those who received at least one dose of Tamiflu . . . 60% survived . . . as opposed to only 24% who received no antivirals.
While we would all prefer to have rock-solid, indisputable evidence based on well-mounted RCTs proving the effectiveness of neuraminidase inhibitors like Oseltamivir, the preponderance of evidence we have today indicates that NAIs can have a substantial positive therapeutic effect on influenza, particularly in high risk patients or with novel flu strains.
And until something better comes along, they really are the only game in town.
