Impact of Outpatient Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis

Background. While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the i...

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Bibliographic Details
Published in:Clinical infectious diseases 2017-05, Vol.64 (10), p.1328-1334
Main Authors: Venkatesan, Sudhir, Myles, Puja R., Leonardi-Bee, Jo, Muthuri, Stella G., Al Masri, Malak, Andrews, Nick, Bantar, Carlos, Dubnov-Raz, Gal, Gérardin, Patrick, Koay, Evelyn S. C., Loh, Tze Ping, Memish, Ziad, Miller, Elizabeth, Oliva, Maria E., Rath, Barbara A., Schweiger, Brunhilde, Tang, Julian W., Tran, Dat, Vidmar, Tjasa, Waight, Pauline A., Nguyen-Van-Tam, Jonathan S.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Ambulatory Care
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antiviral Agents - administration & dosage
Antiviral Agents - therapeutic use
ARTICLES AND COMMENTARIES
Communities
Confidence intervals
Dyspnea
Enzyme Inhibitors - administration & dosage
Enzyme Inhibitors - therapeutic use
Exo-a-sialidase
Female
Hospitalization
Humans
Impact analysis
Infections
Influenza
Influenza A
Influenza A Virus, H1N1 Subtype - drug effects
Influenza, Human - diagnosis
Influenza, Human - drug therapy
Influenza, Human - virology
Major
Male
Meta-analysis
Middle Aged
Neuraminidase - antagonists & inhibitors
Odds Ratio
Outpatients
Patients
Prescription drugs
Regression Analysis
Respiration
Risk Factors
Viruses
Young Adult
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Summary:Background. While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection. Methods. We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including "study center" as a random intercept to account for differences in baseline hospitalization rate between centers. Results. We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20–0.30). Conclusions. In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cix127