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Oseltamivir effective when administered early for H5N1
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Oseltamivir worked best when given early, before onset of respiratory failure among people with influenza virus A subtype H5N1, according to recent data.
“Avian influenza is a frightening disease,” Nancy Dreyer, PhD, MPH, global chief of scientific affairs at Quintiles Outcome, told Infectious Disease News. “Case-fatality rates can be in excess of 80% and death generally comes within 10 days of symptom onset. Oseltamivir is the mainstay of influenza treatment and patients who commence treatment within two days of symptom onset had substantially reduced risk of death.”
The researchers used data from 10 countries, obtained from the Avian Influenza Registry, on 215 patients who received oseltamivir (Tamiflu, Genentech) for laboratory-confirmed H5N1 infection. They analyzed the risk for death among these patients.
Half of the patients were male, and the median age was 18 years. The highest case-fatality rate was in Indonesia, where viral clade 2.1 was circulated. The lowest case-fatality rates were in countries where viral clade 2.2 was circulation, which included Azerbaijan, Egypt, Pakistan and Turkey.
Among patients who received the treatment 2 or fewer days after symptom onset, the case-fatality rate was 18.2% vs. 62.8% for those who received treatment later. Antibiotic treatment did not affect survival, but corticosteroid treatment was associated with a higher case-fatality rate. Patients who had respiratory failure at the time of treatment initiation were more likely to die of H5N1 infection.
“When faced with a potential case of avian influenza, it is wise to administer oseltamivir as early as possible on an empiric basis, without waiting for laboratory confirmation,” Dreyer said. “More study is needed to identify and understand the role of adjunctive therapies to reduce the risk of mortality when antivirals such as oseltamivir are introduced late in the course of illness.”
Disclosure: The researchers report financial relationships with F. Hoffmann-La Roche.
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