Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: An individual participant data meta-analysis

Stella G Muthuri, Sudhir Venkatesan, Puja R Myles, Jo Leonardi-Bee, Wei Shen Lim, Abdullah Al Mamun, Ashish P Anovadiya, Wildo N Araújo, Eduardo Azziz-Baumgartner, Clarisa Báez, Carlos Bantar, Mazen M Barhoush, Matteo Bassetti, Bojana Beovic, Roland Bingisser, Isabelle Bonmarin, Victor H Borja-Aburto, Bin Cao, Jordi Carratala, María R Cuezzo & 21 others Justin T Denholm, Samuel R Dominguez, Pericles A D Duarte, Gal Dubnov-Raz, Marcela Echavarria, Sergio Fanella, James Fraser, Zhancheng Gao, Patrick Gérardin, Maddalena Giannella, Sophie Gubbels, Jethro Herberg, Anjarath L Higuera Iglesias, Peter H Hoeger, Matthias Hoffmann, Xiaoyun Hu, Quazi T Islam, Mirela F Jiménez, Amr Kandeel, Gerben Keijzers, PRIDE Consortium Investigators

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Abstract

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.

METHODS: A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.

RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)].

CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

Original languageEnglish
Pages (from-to)192-204
Number of pages13
JournalInfluenza and Other Respiratory Viruses
Volume10
Issue number3
DOIs
Publication statusPublished - May 2016
Externally publishedYes

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Neuraminidase
Human Influenza
Meta-Analysis
Pneumonia
Odds Ratio
H1N1 Subtype Influenza A Virus
Virus Diseases
Therapeutics
Mortality
Pandemics
Adrenal Cortex Hormones
Anti-Bacterial Agents
Incidence

Cite this

Muthuri, S. G., Venkatesan, S., Myles, P. R., Leonardi-Bee, J., Lim, W. S., Al Mamun, A., ... PRIDE Consortium Investigators (2016). Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: An individual participant data meta-analysis. Influenza and Other Respiratory Viruses, 10(3), 192-204. https://doi.org/10.1111/irv.12363
Muthuri, Stella G ; Venkatesan, Sudhir ; Myles, Puja R ; Leonardi-Bee, Jo ; Lim, Wei Shen ; Al Mamun, Abdullah ; Anovadiya, Ashish P ; Araújo, Wildo N ; Azziz-Baumgartner, Eduardo ; Báez, Clarisa ; Bantar, Carlos ; Barhoush, Mazen M ; Bassetti, Matteo ; Beovic, Bojana ; Bingisser, Roland ; Bonmarin, Isabelle ; Borja-Aburto, Victor H ; Cao, Bin ; Carratala, Jordi ; Cuezzo, María R ; Denholm, Justin T ; Dominguez, Samuel R ; Duarte, Pericles A D ; Dubnov-Raz, Gal ; Echavarria, Marcela ; Fanella, Sergio ; Fraser, James ; Gao, Zhancheng ; Gérardin, Patrick ; Giannella, Maddalena ; Gubbels, Sophie ; Herberg, Jethro ; Higuera Iglesias, Anjarath L ; Hoeger, Peter H ; Hoffmann, Matthias ; Hu, Xiaoyun ; Islam, Quazi T ; Jiménez, Mirela F ; Kandeel, Amr ; Keijzers, Gerben ; PRIDE Consortium Investigators. / Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia : An individual participant data meta-analysis. In: Influenza and Other Respiratory Viruses. 2016 ; Vol. 10, No. 3. pp. 192-204.
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title = "Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: An individual participant data meta-analysis",
abstract = "BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.METHODS: A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.RESULTS: Of 20 634 included participants, 5978 (29·0{\%}) had IRP; conversely, 3349 (16·2{\%}) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95{\%} CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)].CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.",
author = "Muthuri, {Stella G} and Sudhir Venkatesan and Myles, {Puja R} and Jo Leonardi-Bee and Lim, {Wei Shen} and {Al Mamun}, Abdullah and Anovadiya, {Ashish P} and Ara{\'u}jo, {Wildo N} and Eduardo Azziz-Baumgartner and Clarisa B{\'a}ez and Carlos Bantar and Barhoush, {Mazen M} and Matteo Bassetti and Bojana Beovic and Roland Bingisser and Isabelle Bonmarin and Borja-Aburto, {Victor H} and Bin Cao and Jordi Carratala and Cuezzo, {Mar{\'i}a R} and Denholm, {Justin T} and Dominguez, {Samuel R} and Duarte, {Pericles A D} and Gal Dubnov-Raz and Marcela Echavarria and Sergio Fanella and James Fraser and Zhancheng Gao and Patrick G{\'e}rardin and Maddalena Giannella and Sophie Gubbels and Jethro Herberg and {Higuera Iglesias}, {Anjarath L} and Hoeger, {Peter H} and Matthias Hoffmann and Xiaoyun Hu and Islam, {Quazi T} and Jim{\'e}nez, {Mirela F} and Amr Kandeel and Gerben Keijzers and {PRIDE Consortium Investigators}",
note = "{\circledC} 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.",
year = "2016",
month = "5",
doi = "10.1111/irv.12363",
language = "English",
volume = "10",
pages = "192--204",
journal = "Influenza and Other Respiratory Viruses",
issn = "1750-2640",
publisher = "Wiley-Blackwell",
number = "3",

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Muthuri, SG, Venkatesan, S, Myles, PR, Leonardi-Bee, J, Lim, WS, Al Mamun, A, Anovadiya, AP, Araújo, WN, Azziz-Baumgartner, E, Báez, C, Bantar, C, Barhoush, MM, Bassetti, M, Beovic, B, Bingisser, R, Bonmarin, I, Borja-Aburto, VH, Cao, B, Carratala, J, Cuezzo, MR, Denholm, JT, Dominguez, SR, Duarte, PAD, Dubnov-Raz, G, Echavarria, M, Fanella, S, Fraser, J, Gao, Z, Gérardin, P, Giannella, M, Gubbels, S, Herberg, J, Higuera Iglesias, AL, Hoeger, PH, Hoffmann, M, Hu, X, Islam, QT, Jiménez, MF, Kandeel, A, Keijzers, G & PRIDE Consortium Investigators 2016, 'Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia: An individual participant data meta-analysis' Influenza and Other Respiratory Viruses, vol. 10, no. 3, pp. 192-204. https://doi.org/10.1111/irv.12363

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia : An individual participant data meta-analysis. / Muthuri, Stella G; Venkatesan, Sudhir; Myles, Puja R; Leonardi-Bee, Jo; Lim, Wei Shen; Al Mamun, Abdullah; Anovadiya, Ashish P; Araújo, Wildo N; Azziz-Baumgartner, Eduardo; Báez, Clarisa; Bantar, Carlos; Barhoush, Mazen M; Bassetti, Matteo; Beovic, Bojana; Bingisser, Roland; Bonmarin, Isabelle; Borja-Aburto, Victor H; Cao, Bin; Carratala, Jordi; Cuezzo, María R; Denholm, Justin T; Dominguez, Samuel R; Duarte, Pericles A D; Dubnov-Raz, Gal; Echavarria, Marcela; Fanella, Sergio; Fraser, James; Gao, Zhancheng; Gérardin, Patrick; Giannella, Maddalena; Gubbels, Sophie; Herberg, Jethro; Higuera Iglesias, Anjarath L; Hoeger, Peter H; Hoffmann, Matthias; Hu, Xiaoyun; Islam, Quazi T; Jiménez, Mirela F; Kandeel, Amr; Keijzers, Gerben; PRIDE Consortium Investigators.

In: Influenza and Other Respiratory Viruses, Vol. 10, No. 3, 05.2016, p. 192-204.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09-related pneumonia

T2 - An individual participant data meta-analysis

AU - Muthuri, Stella G

AU - Venkatesan, Sudhir

AU - Myles, Puja R

AU - Leonardi-Bee, Jo

AU - Lim, Wei Shen

AU - Al Mamun, Abdullah

AU - Anovadiya, Ashish P

AU - Araújo, Wildo N

AU - Azziz-Baumgartner, Eduardo

AU - Báez, Clarisa

AU - Bantar, Carlos

AU - Barhoush, Mazen M

AU - Bassetti, Matteo

AU - Beovic, Bojana

AU - Bingisser, Roland

AU - Bonmarin, Isabelle

AU - Borja-Aburto, Victor H

AU - Cao, Bin

AU - Carratala, Jordi

AU - Cuezzo, María R

AU - Denholm, Justin T

AU - Dominguez, Samuel R

AU - Duarte, Pericles A D

AU - Dubnov-Raz, Gal

AU - Echavarria, Marcela

AU - Fanella, Sergio

AU - Fraser, James

AU - Gao, Zhancheng

AU - Gérardin, Patrick

AU - Giannella, Maddalena

AU - Gubbels, Sophie

AU - Herberg, Jethro

AU - Higuera Iglesias, Anjarath L

AU - Hoeger, Peter H

AU - Hoffmann, Matthias

AU - Hu, Xiaoyun

AU - Islam, Quazi T

AU - Jiménez, Mirela F

AU - Kandeel, Amr

AU - Keijzers, Gerben

AU - PRIDE Consortium Investigators

N1 - © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

PY - 2016/5

Y1 - 2016/5

N2 - BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.METHODS: A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)].CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

AB - BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.METHODS: A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids.RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)].CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.

UR - http://www.scopus.com/inward/record.url?scp=84958793964&partnerID=8YFLogxK

U2 - 10.1111/irv.12363

DO - 10.1111/irv.12363

M3 - Article

VL - 10

SP - 192

EP - 204

JO - Influenza and Other Respiratory Viruses

JF - Influenza and Other Respiratory Viruses

SN - 1750-2640

IS - 3

ER -