www.medpagetoday.com Open in urlscan Pro
23.200.1.40  Public Scan

Form analysis
1 forms found in the DOM

/search

<form role="search" action="/search" class="active" id="global-nav-search-bar">
  <div class="input_container">
    <label for="global-nav-search-input" class="screen-readers-only">Search</label>
    <input id="global-nav-search-input" name="q" data-name="header-search" type="search" autocomplete="off" class="search_field searchField" placeholder="Enter Search Terms">
  </div>
</form>

Text Content

 * Edit Profile
 * Manage Subscriptions
 * CME Tracker
 * Log Out

Login
Sign Up
search
Search
 * Specialties
   Back
    * Allergy & Immunology
    * Anesthesiology
    * Cardiology
    * Critical Care
    * Dermatology
    * Emergency Medicine
    * Endocrinology
    * Gastroenterology
    * Genetics
    * Geriatrics
    * HIV / AIDS
    * Hospital-Based Medicine
    * Infectious Disease
    * Nephrology
    * Neurology
    * Nursing
    * OB / GYN
    * Oncology / Hematology
    * Ophthalmology
    * Orthopedics
    * Pain Management
    * Pathology
    * Pediatrics
    * Pharmacy
    * Primary Care
    * Psychiatry
    * Pulmonology
    * Radiology
    * Rheumatology
    * Surgery
    * Transplantation
    * Urology

 * Opinion
 * Health Policy
 * Meetings
 * Special Reports
 * Break Room
 * Conditions
   Back
    * Condition Centers
    * Making the Rounds
    * Medical Journeys

 * Society Partners
   Back
    * AAD Reading Room
    * ACR Reading Room
    * AGA Reading Room
    * ASCO Reading Room
    * Endocrine Society Reading Room
    * IDSA Reading Room

 * CME
 * Healthcare Jobs
 * Synopsi

Infectious Disease > Flu & URI


TAMIFLU A BUST FOR PREVENTING FLU ADMISSIONS, META-ANALYSIS FINDS


— "I WOULDN'T PRESCRIBE IT TO AN OTHERWISE HEALTHY PERSON," RESEARCHER SAYS

by Ingrid Hein, Staff Writer, MedPage Today June 12, 2023


MedpageToday

Share on Facebook. Opens in a new tab or window
Share on Twitter. Opens in a new tab or window
Share on LinkedIn. Opens in a new tab or window

email article


Oseltamivir (Tamiflu) has not panned out for reducing the risk of influenza
hospitalization, according to a large meta-analysis.

Among over 6,000 flu patients across 15 studies, the 0.14-percentage point
difference in hospitalization rate between those who took oseltamivir and those
who did not was not significant (RR 0.77, 95% CI 0.47-1.27), Emily McDonald, MD,
MSc, of McGill University Health Centre in Montreal, and colleagues reported in
JAMA Internal Medicineopens in a new tab or window.



"I wouldn't prescribe it to an otherwise healthy person," McDonald told MedPage
Today. "There was little evidence that it would prevent you from going to the
hospital."

What's more, she added, "it's not completely benign. It does cause uncomfortable
side effects."

Patients taking the antiviral were more likely to have gastrointestinal (GI)
side effects, including nausea (RR 1.43, 95% CI 1.13-1.82) and vomiting (RR
1.83, 95% CI 1.28-2.63), according to the study.

"That side effect might lead to dehydration, and so it could be more pronounced
in older people or people who have a tendency towards dehydration -- people with
diabetes might be more affected by it," McDonald said. "So certainly, for some
populations, it could be more harmful than just a nuisance side effect."

Oseltamivir is indicated for prophylaxis and to treat acute, uncomplicated
influenza in patients symptomatic for no more than 2 days. In fact, the U.S.
government has a stockpile of the antiviral medication as part of its national
pandemic responses.



Studies have shown the antiviral helps speed recovery from influenza. And a
recent pediatric studyopens in a new tab or window showed evidence that the
medication reduced length of stay, readmission, intensive care transfers, and
death for children with influenza who were given the antiviral treatment,
notably for those that were treated the day of admission.

"There is good evidence that oseltamivir, a drug of known antiviral activity,
shortens the duration of influenza when administered within 48 hours," Arnold
Monto, MD, from the School of Public Health at the University of Michigan in Ann
Arbor, told MedPage Today by email.

However, McDonald's group characterized this 16.8- to 25.2-hour reduction as
"small."


MEDICAL NEWS FROM AROUND THE WEB

STAT
1
A breakthrough cystic fibrosis drug gave them the gift of time. But miracles
come with complications.
opens in a new tab or window
Harvard Health
2
When — and how — should you be screened for colon cancer? - Harvard Health
opens in a new tab or window
ABC News
3
Mississippi sees 10-fold increase in babies born with syphilis since 2016:
Report
opens in a new tab or window

"Whether this decrease is meaningful when compared with medication costs, an
increase in nonsevere adverse events, and the opportunity cost of missing out on
the discovery of more effective therapies is a topic of study for health care
economists and could be discussed on an individual patient basis," they wrote.



McDonald contended that the current oseltamivir treatment recommendations may
need to be reviewed. "I hope that we stop using it in populations where we don't
see an important effect, and I hope it inspires researchers to run the study
that is needed, which is a large placebo-controlled randomized trial in the
highest-risk individuals."

Influenza resolves on its own, she explained, but sometimes there's no time to
explain that to a sick patient. "The barrier to prescribing is lower than the
barrier to explaining why you don't need to take a medication or why you
shouldn't prescribe something; sometimes time pressures in the office can lead
to us prescribing treatments that are not as effective as we'd like them to be."

A prescription for rest and hydration may be what the majority of patients need
most, she added. "Overprescribing is a big problem ... We do tend to prescribe
antibiotics and antivirals more than we need to."



The meta-analysis didn't suggest a benefit in high-risk populations overall (RR
0.90 vs 0.63 in lower risk patients). Still, patients in selected higher-risk
groups could benefit from oseltamivir, and that should be discussed, she said.

"I might prescribe it to someone with a kidney transplant, someone at high risk
for getting very sick and with a lack of immune system to fight the infection,"
McDonald noted.

McDonald and her colleagues noted that in further subgroup analysis, older
adults with mean age of 65 or older (RR 0.99, 95% CI 0.19-5.13) appeared to gain
even less than those younger than 65 (RR 0.72, 95% CI 0.39-1.34).

Monto noted that duration of illness was what previous studies had been aimed at
showing, whereas the hospitalization endpoint used in the meta-analysis had a
low event rate -- occurring in only 0.6% of non-treated individuals. "As the
authors themselves state, it would have taken a far larger study to show a
significant effect."



"Accordingly, the current recommendations for treatment should stay in place,"
he told MedPage Today. "Interesting, the authors did not find any of the more
severe side effects that some have attributed to the drug. Only the GI side
effects that all accept as related."

Of 2,352 studies found in the literature, 15 were included in the meta-analysis;
nine of these (60%) were sponsored by Roche and were conducted between 1998 and
2006.

Criteria for study inclusion included having data on hospital outcomes for
patients age 12 and up with confirmed influenza (PCR test or viral culture) who
received an oral dose of 75 mg of oseltamivir twice daily for 5 days and having
a comparator group of placebo or standard of care.

Of the 6,295 individuals (mean age 45 years) in the intention-to-treat
population among the 15 included studies, 54% were female, with 70% identifying
as white and 21% as Asian. Most (60%) of the cases were confirmed to be
influenza A.



The authors noted study limitations, including that both industry and
non-industry trials were included, a young mean age of patients, data on only
first hospitalizations, and exclusion of high-dose treatment with oseltamivir
and of observational data.

The results included all-cause hospitalization with influenza, rather than
hospitalization with influenza only, in order to include hospitalizations that
may be due to side effects of oseltamivir. "This is particularly relevant for
older high-risk adults where seemingly mild gastrointestinal adverse effects
might still increase the risk of hospitalization through anorexia and
dehydration," the researchers explained.



 * Ingrid Hein is a staff writer for MedPage Today covering infectious disease.
   She has been a medical reporter for more than a decade. Follow

Disclosures

McDonald reported research salary awards from Fonds de recherche du Québec –
Santé outside the submitted work and being an investigator on an inpatient
oseltamivir study.

No other relevant conflicts of interest with industry were reported.

Primary Source

JAMA Internal Medicine

Source Reference: opens in a new tab or windowMcDonald E, et al "Evaluation of
oseltamivir used to prevent hospitalization in outpatients with influenza: a
systematic review and meta-analysis" JAMA Intern Med 2023; DOI:
10.1001/jamainternmed.2023.0699.

Share on Facebook. Opens in a new tab or window
Share on Twitter. Opens in a new tab or window
Share on LinkedIn. Opens in a new tab or window

email article
2 Comments Please enable JavaScript to view the comments powered by Disqus.


MEDICAL NEWS FROM AROUND THE WEB

STAT
1
A breakthrough cystic fibrosis drug gave them the gift of time. But miracles
come with complications.
opens in a new tab or window
Harvard Health
2
When — and how — should you be screened for colon cancer? - Harvard Health
opens in a new tab or window
ABC News
3
Mississippi sees 10-fold increase in babies born with syphilis since 2016:
Report
opens in a new tab or window






MEDICAL NEWS FROM AROUND THE WEB

STAT
1
A breakthrough cystic fibrosis drug gave them the gift of time. But miracles
come with complications.
opens in a new tab or window
Harvard Health
2
When — and how — should you be screened for colon cancer? - Harvard Health
opens in a new tab or window
ABC News
3
Mississippi sees 10-fold increase in babies born with syphilis since 2016:
Report
opens in a new tab or window
Clinical Advisor
4
Barriers to Timely Follow-up for Heart Failure Hospitalization
opens in a new tab or window
The American Journal of Psychiatry
5
Recent Secular Trends of Body Mass Index in Individuals With Bipolar Disorders
and in the General Population.
opens in a new tab or window
Journal of Clinical Oncology
6
Which Patients With Rhabdomyosarcoma Need Radiotherapy? Analysis of the
Radiotherapy Strategies of the CWS-96 and CWS-2002P Studies and SoTiSaR
Registry.
opens in a new tab or window


RECOMMENDED FOR YOU

1

Podcast
Carbohydrates and Long-Term Weight Change; Value of Cardiac Transfers
2

Pulmonology
Fancy Nasal Suction Device Makes Little Difference in Infant Bronchiolitis
3

Video
Should Scientists Openly Debate Vaccine Policies?
4

Public Health & Policy
CVS Pulls Phenylephrine Cold Meds; Doc's Murder/Suicide; Red Meat and Diabetes
5

Special Reports
COVID Viral Load Peaks Later Now Than Early in Pandemic
6

Infectious Disease
Paxlovid Priced at $1,390! Snoozing the Alarm and Health; Medical Aid Heads to
Gaza


Visit us on Facebook. Opens in a new tab or window
Visit us on Twitter. Opens in a new tab or window
Visit us on Instagram. Opens in a new tab or window
Visit us on LinkedIn. Opens in a new tab or window
Visit us on TikTok. Opens in a new tab or window
Visit us on YouTube. Opens in a new tab or window
Subscribe for Free
About Help Center Terms of Use Privacy Policy
Do Not Sell My Personal Information Advertise with us AdChoices Accessibility
Statement
visit everydayhealthgroup.com

visit healthecareers.com/
visit medpagetoday.com
visit primeinc.org

The material on this site is for informational purposes only, and is not a
substitute for medical advice, diagnosis or treatment provided by a qualified
health care provider.
© 2005–2023 MedPage Today, LLC, a Ziff Davis company. All rights reserved.
Medpage Today is among the federally registered trademarks of MedPage Today, LLC
and may not be used by third parties without explicit permission.