Although it runs contrary to to what some in the `popular press’- and some activists - would like to project, there is a substantial body of evidence showing that antiviral medications – like oseltamivir (aka Tamiflu ®) - can make a real difference in the outcome of severe influenza infection.
Unfortunately, what most people know or remember about these drugs comes from hyperbolic media reports like the Guardian’s Tamiflu’s limitations in preventing pandemics exposed by trial results and the Daily Mail’s Ministers blew £650MILLION on useless anti-flu drugs.
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.
Fueling this fire have been repeated Cochrane group analyses that have found insufficient evidence that the drug reduces seasonal influenza complications in healthy adults, although they limit their analyses to RCTs (Randomized Controlled Trials) of which few exist for this drug.
We’ve seen numerous observational studies that show antivirals are useful in the treatment of severe flu (see Study: Antivirals Saved Lives Of Pregnant Women and Study: The Benefits Of Antiviral Therapy During the 2009 Pandemic), particularly in those with heightened risk factors.
Sadly, many people (and probably even some doctors) have come away with the erroneous impression that these drugs are worthless – or worse. We saw evidence of this last summer, in CID Journal: Under Utilization Of Antivirals For At Risk Flu Patients, showing that antiviral drugs are underused for at-risk patients, while antibiotics (which don’t work against viral infections) are overused.
Working to address these beliefs, have been the CDC (see The CDC Responds To The Cochrane Tamiflu Study) and the UK PHE (see Revisiting Influenza Antiviral Recommendations), while last January we saw a meta-analysis in The Lancet that supported its use as well (see CIDRAP News On The Lancet Oseltamivir (Tamiflu ®) Meta-Analysis).
Today we’ve new CDC research that looked at the extended care needs of elderly post-hospital-discharge flu patients who either received, or did not receive, early antiviral treatments. As you will see, early administration of antivirals was associated with reductions in length of hospital stays, and reduced odds of needing extended care after discharge.
Impact of prompt influenza antiviral treatment on extended care needs after influenza hospitalization among community-dwelling older adults
Sandra S. Chaves1, Alejandro Pérez1, Lisa Miller2, Nancy M. Bennett3, Ananda Bandyopadhyay4, Monica M. Farley5,6, Brian Fowler7, Emily B. Hancock8, Pam Daily Kirley9, Ruth Lynfield10, Patricia Ryan11, Craig Morin10, William Schaffner12, Ruta Sharangpani13, Mary Lou Lindegren12, Leslie Tengelsen14, Ann Thomas15, Mary B. Hill16, Kristy K. Bradley17, Oluwakemi Oni18, James Meek19, Shelley Zansky20, Marc-Alain Widdowson1, and Lyn Finelli1
Background. Patients hospitalized with influenza may require extended care upon discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥65 years hospitalized with influenza.
Methods. We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility upon hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay (LOS) using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤4 days) and late (>4 days) in reference to date of illness onset.
Results. Among 6,593 community-dwelling adults aged ≥65 years hospitalized for influenza, 18% required extended care at discharge. Need for care increased with age and neurologic disorders, ICU admission, and pneumonia were predictors of care needs. Early treatment reduced the odds of extended care after hospital discharge for those hospitalized ≤2 or >2 days from illness onset (adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.17, 0.85, and aOR 0.75; 95% CI 0.56, 0.97 respectively). Early treatment was also independently associated with reduction in LOS for those hospitalized ≤2 days from illness onset (adjusted hazard ratio [aHR] 1.81; 95% CI 1.43, 2.30) or >2 days (aHR 1.30; 95% CI 1.20, 1.40).
Conclusions. Prompt antiviral treatment decreases the impact of influenza on older adults through shorten hospitalization and reduced extended care needs.
The CDC has released a statement regarding this study, excerpts of which follow:
For Immediate Release: Wednesday, September 2, 2015
Early treatment of flu-hospitalized people 65 and older with flu antiviral medications cuts the duration of their hospital stay and reduces their risk of needing extended care after discharge, a new CDC study finds. The study is the first to look at the benefits of early antiviral treatment on preventing the need for extended care in community-dwelling flu-hospitalized people 65 and older.
Because people 65 and older are at high risk of serious flu complications, CDC recommends that they be treated for flu with influenza antiviral medications as early as possible because these drugs work best when started early. The study, published today in the journal Clinical Infectious Diseases, supports this recommendation.
“Flu can be extremely serious in older people, leading to hospitalization and in some cases long-term disability. This important study shows that people 65 and older should seek medical care early when they develop flu symptoms,” says Dr. Dan Jernigan, director of CDC's Influenza Division.
The study found that community-dwelling patients 65 years and older who sought medical care or who were hospitalized within two days of illness onset and who were treated with antiviral medications early (in the first four days of illness) had hospital stays that were substantially shorter than those who received treatment later (after 4 days of illness onset). This benefit was observed even among those who sought care later (more than two days after they got sick), but the reduction in hospital stay was not as great.
Similarly, early treatment was associated with patients being 25 percent to 60 percent less likely to need extended care after leaving the hospital. The study authors suggest that the shorter hospital stays associated with early treatment could account for the reduced risk of needing extended care after discharge since lengthy bed restriction can lead to disability. Other factors like older age, the presence of neurologic disorders, intensive care unit (ICU) admission, and pneumonia at admission were also independent risk factors for extended care needs.
While far from perfect, and certainly not a `cure’ for flu, antivirals remain our best pharmaceutical option for the treatment of severe influenza.