Wednesday, February 17, 2016

ECDC: Expert Opinion On Effectiveness of NAI Antivirals For Influenza

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For nearly a decade critics have demonized NAI antivirals (particularly Tamiflu) as being either useless, or in some extreme cases, dangerous. The British press, in particular, has promoted the notion using hyperbolic headlines such as the Daily Mail's: Ministers blew £650MILLION on useless anti-flu drug.

Fueling this controversy have been a number of Cochrane group analyses that found insufficient evidence that oseltamivir substantially reduces seasonal influenza complications in healthy adults

A conclusion based primarily on the fact that the Cochrane group routinely excludes observational studies in favor of more rigorous, but difficult to mount RCTs (Randomized Controlled Trials), of which few exist for Tamiflu.

Doctors who actually use these antiviral drugs report far better results, and over the years we've looked at a number of these studies, including:

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 importantly with so many new  avian flu viruses on the rise, in 2010’s Study: Antiviral Therapy For H5N1, a study of outcomes of H5N1 patients who either received, or did not receive, antiviral treatment found: 
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.
Because of this evidence, we’ve seen a push back by public health agencies against the negative perceptions influenza antivirals:

Wellcome Trust/AMS Report On Antivirals For Influenza
The CDC Responds To The Cochrane Group’s Tamiflu Study 

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

CID Journal: Outcomes Of Prompt Influenza Antiviral Treatment Of Older Adults

CDC Expert Commentary (Video) On Use Of Neuraminidase Antiviral Drugs


To these reports we can add a new one, this time from the ECDC, which has just published a 32 page expert opinion on the effectiveness of NAI antivirals for influenza, which finds evidence supporting the use of NAIs for the treatment and prophylaxis of influenza.

This expert opinion is open for public comment until March 16th. 

First the ECDC's announcement, then a link to download the full report:

Neuraminidase inhibitors for the treatment and prophylaxis of influenza: public consultation opens

17 Feb 2016

Current recommendations on the use of the neuraminidase inhibitors oseltamivir and zanamivir for the treatment and prophylaxis of influenza disease are appropriate, finds a new expert opinion from ECDC, which today opens for public consultation.

The review of recent systematic reviews and meta-analyses on the use of neuraminidase inhibitors for prevention and treatment of influenza finds that the studies presented strengthen the evidence base for the use of these antiviral treatments.

Continued debate surrounding the effectiveness and safety of these antivirals has led to some uncertainty within the public health community regarding the antivirals’ potential benefits as a treatment option or as prophylaxis for influenza disease. As a result, the public health benefits may be being missed.

The ECDC expert opinion demonstrates that there is evidence for use of neuraminidase inhibitors for treatment and prophylaxis of influenza. It also highlights the importance of further studies and the urgent need for the development of new antivirals with greater efficacy.   
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Preliminary Scientific Advice: Expert Opinion on neuraminidase inhibitors for prevention and treatment of influenza
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17 Feb 2016


A consultation with European and international public health experts was convened to review data presented in newly conducted systematic reviews and meta-analyses regarding influenza antivirals, in order to develop an ECDC Expert Opinion.

In line with ECDC’s commitment to openness and transparency, and in order to receive comments from the scientific community and stakeholders, ECDC is launching a public consultation on the ‘Expert Opinion on neuraminidase inhibitors for prevention and treatment of influenza – review of recent systematic reviews and meta-analyses’.  
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Expert Opinion on neuraminidase inhibitors for prevention and treatment of influenza - See more at: