{"id":811,"date":"2015-08-27T14:37:19","date_gmt":"2015-08-27T14:37:19","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=811"},"modified":"2017-08-21T11:33:08","modified_gmt":"2017-08-21T11:33:08","slug":"primary-care-corner-with-geoffrey-modest-md-oseltamivir-for-influenza","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/08\/27\/primary-care-corner-with-geoffrey-modest-md-oseltamivir-for-influenza\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Oseltamivir for Influenza"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>As we approach flu season again, there was another article looking at the effectiveness of oseltamivir (see\u00a0DOI: 10.1093\/infdis\/jiv058\u200b). This was an observational community-based study in Hong Kong from 2008-2013.<\/p>\n<p>Background:<\/p>\n<ul>\n<li>Oseltamivir has been shown\u00a0in RCTs\u00a0to reduce the duration of fever and respiratory symptoms in adults and kids with uncomplicated flu infections. This effect, in a recent large\u00a0BMJ meta-analysis,\u00a0was pretty marginal, finding some shortening of symptoms, decreased transmission to household contacts, but significant increase in adverse events (see\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/05\/06\/primary-care-corner-with-geoffrey-modest-md-neuraminidase-inhibs-for-flu-lack-of-significant-efficacy\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/05\/06\/primary-care-corner-with-geoffrey-modest-md-neuraminidase-inhibs-for-flu-lack-of-significant-efficacy\/<\/a> )<\/li>\n<\/ul>\n<p>Details:<\/p>\n<ul>\n<li>This was an\u00a0observational study of 582 patients with laboratory-confirmed influenza (121\u00a0children&lt;5yo, 250 were &gt;18yo&#8211; I&#8217;m not sure of the real numbers since\u00a0what they stated in the text differed from the table). Baseline characteristics were similar, though more of the treated ones had myalgias and fewer got antipyretics.\u00a0223 were treated with oseltamivir (185 with influenza A and 38 with influenza B), and 359 did not get antivirals (258 with influenza A and 101 with B)<\/li>\n<\/ul>\n<p>Results:<\/p>\n<ul>\n<li>For those who took oseltamivir within 24 hours of onset of symptoms, the median duration of &#8220;all self-reported symptoms&#8221; until\u00a0complete resolution of symptoms was reduced\u00a0by 56%, including resolution of fever and respiratory symptoms (all with p&lt;0.01). There was no significant oseltamivireffect\u00a0if the onset of\u00a0symptoms was\u00a0&gt;24 hours previously. On reviewing the graphs of symptom reduction, there was a 10% difference after 1\u00a0day, 20% after 2 days and 35% after 3 days (i.e., the decrease in symptoms happened pretty quickly). Symptoms were only assessed once a day.<\/li>\n<li>Those on oseltamivir had no significant decreases in either viral shedding or in transmission of influenza to household contacts, independent of duration of symptoms in the index patient.<\/li>\n<\/ul>\n<p>So, these results differed a bit from the BMJ meta-analysis from 4 months ago which really found minimal efficacy (e.g., decrease in time to first alleviation of symptoms from 7 days to 6.3 days). Of note, in the current\u00a0study, there was no change in viral shedding or\u00a0household transmission, and its effects were limited to those initiating meds within 24 hours of the onset of symptoms. This was an observational study and is therefore not conclusive\u200b (we know that those getting meds were a little different than those who did not, and, most importantly,\u00a0was there a placebo effect??).\u00a0 But, the CDC still recommends oseltamivir (see\u00a0<a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr6001a1.htm\">http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr6001a1.htm<\/a> ), especially in higher risk individuals (&lt;2yo, &gt;64yo, those with chronic medical conditions, pregnant women, those with BMI&gt;40, those in chronic care facilities), given as soon as possible after onset of symptoms, but especially if symptoms\u00a0\u00a0&lt;48 hours (can be longer with severe symptoms or hospitalization). Bottom line for me: I\u00a0continue to be underwhelmed by these meds, given the minimal efficacy in the large meta-analysis and high rate of adverse effects. And, of course, the effectiveness\u00a0of these drugs in the future\u00a0will be affected by neuraminidase inhibitor resistance, which has played a role in the past.<\/p>\n<p>For very recent flu vaccine recommendations by the CDC, see\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/08\/17\/primary-care-corner-with-geoffrey-modest-md-flu-vaccine-recommendations-2015-6\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/08\/17\/primary-care-corner-with-geoffrey-modest-md-flu-vaccine-recommendations-2015-6\/<\/a> .\u200b<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Oseltamivir for Influenza  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/08\/27\/primary-care-corner-with-geoffrey-modest-md-oseltamivir-for-influenza\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-811","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/811","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=811"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/811\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=811"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=811"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=811"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}