Wednesday, September 30, 2015

The Conversation: The Rise & Fall Of The Challenge To Tamiflu


Photo Credit – Wikipedia




One of the popular memes on the internet and in tabloid media is that the influenza antiviral drug oseltamivir (Tamiflu ®) is either A) Ineffective or B) Ineffective and Dangerous.   A cherry picking of data, along with hyperbolic media reports – like the Daily Mail’s Ministers blew £650MILLION on useless anti-flu drugs -  have helped to drive these beliefs.

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 in the past have led to critical editorials in the BMJ, and frequent excoriation in the British press.


Added to this have been repeated Cochrane group analyses that have found insufficient evidence that the drug reduces seasonal influenza complications in healthy adults, although they limited their analyses to RCTs (Randomized Controlled Trials) of which few exist for this drug.  


Working to address these concerns have been the CDC (see The CDC Responds To The Cochrane Tamiflu Study) and the UK’s PHE (see Revisiting Influenza Antiviral Recommendations). 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).


Over the years we’ve looked at 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. A short list of some of these blogs includes:

CID Journal: Outcomes Of Prompt Influenza Antiviral Treatment Of Older Adults
CDC Expert Commentary (Video) On Use Of Neuraminidase Antiviral Drugs

CID Journal: Under Utilization Of Antivirals For At Risk Flu Patients


Today I’m happy to report that academic news journal The Conversation has a long, and informative overview of the Tamiflu controversy that includes a look at several recent meta-analyses that conclude that Tamiflu is effective in reducing ICU admission, and death, when administered early in the treatment of severe influenza.


While this may not satisfy Tamiflu’s staunchest critics, it is nonetheless reassuring news for clinicians who must decide whether to prescribe the drug.


Highly recommended.



Controversies in medicine: the rise and fall of the challenge to Tamiflu

September 29, 2015 4.08pm EDT

By Jodie McVernon  Associate Professor, Population Health, University of Melbourne

As part of pandemic preparation, in the early 2000s many countries amassed large stockpiles of the influenza neuraminidase inhibitor Tamiflu.  

One of the biggest recent controversies in medicine involves the effectiveness – or otherwise – of the antiviral drug Tamiflu. Governments around the world have stockpiled the drug for use in severe influenza pandemics, but many have raised doubts about its effectiveness.

Influenza causes annual “seasonal” epidemics in temperate countries and circulates year-round in the tropics. Pandemics occur when there’s a relatively new flu virus containing components of bird or swine flu viruses, against which the human population has little protection.

Global pandemic preparedness efforts were spurred in the early 2000s by the emergence of SARS, and highly pathogenic H5N1 influenza in birds, which was associated with rare but often fatal infection in humans. The problem is that the severity of pandemics can vary markedly; from the Spanish flu of 1918-19, which is estimated to have killed 20-50 million people worldwide, to the much milder 2009 swine flu, which resulted in between 150,000 and 250,000 deaths (a similar number to the annual mortality of seasonal epidemics).

Reviewing evidence

(Continue  reading . . .)

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