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Prompt NAI treatment reduced hospital stays by 19% during last flu pandemic
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Neuraminidase inhibitor treatment initiated upon hospitalization decreased patients’ length of stay by 19% overall during the 2009-2010 influenza pandemic, according to findings from a meta-analysis published in The Journal of Infectious Diseases.
“The most pragmatic and important question is whether [neuraminidase inhibitor (NAI)] treatment, started on admission, irrespective of delay since symptom onset, reduces the [length of stay] in hospitalized patients with influenza,” Sudhir Venkatesan, PhD, MPH, research assistant in the University of Nottingham’s division of epidemiology and public health, and colleagues wrote. “Clinically, this is important because there can be significant uncertainty in ascertaining symptom onset, even by the attending physician.”
The meta-analysis included data on 18,309 patients infected with the pandemic influenza A(H1N1) virus from 70 clinical centers in 36 countries, and excluded patients with a length of stay less than 1 day and individuals who died while hospitalized.
The study results showed a 19% overall reduction in length of stay among patients who were promptly administered NAI treatment upon hospitalization compared with those who received it later or not at all (incidence rate ratio, 0.81; 95% CI, 0.78-0.85), with a median decrease of 1.19 days.
NAI treatment initiated less than 2 days after the onset of symptoms as well as NAI treatment administered at any time showed mixed patterns of association with a patient’s length of stay, the researchers reported. They observed an 8% decrease in length of stay in patients who were treated on the day of admission and not admitted to the ICU, and a 28% increase in promptly treated patients with chest radiography-confirmed influenza-related pneumonia.
Length of stay due to influenza can be influenced by a number of other factors, including complications stemming from the infection. According to the CDC, the 2017-2018 influenza season saw the highest spike in hospitalizations related to the virus since 2005 — with an estimated 959,000 patients admitted.
“Our data support current recommendations to treat adults hospitalized with clinically suspected influenza with NAIs as soon as possible upon admission,” the researchers wrote. “If used consistently, this strategy would contribute to the management of surge pressures and health care costs during seasonal influenza epidemics and pandemics.” – by Eamon Dreisbach
References:
CDC. Estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States — 2017–2018 influenza season. https://www.cdc.gov/flu/about/burden/2017-2018.htm. Accessed July 25, 2019
Venkatesan S, et al. J Infect Dis. 2019;doi:10.1093/infdis/jiz152.
Disclosures: Venkatesan reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.
Perspective
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Amesh A. Adalja, MD
There has been considerable controversy in the medical literature regarding the benefits of antiviral therapy for influenza and the optimal timeline for benefit. This controversy has led, unfortunately, to some clinicians refraining from the use of antiviral therapy, even in patients at high risk for complications and even when guidelines clearly recommend their use. The study by Venkatesan and colleagues is a welcome addition that helps establish the benefit of NAI treatment of individuals hospitalized with flu.
This individual participant data meta-analysis demonstrated that during the most recent influenza pandemic, patients hospitalized with the pandemic virus who received treatment experienced a 19% reduction in length of stay. Importantly, the study was focused on nonfatal cases so as not to confound the findings. Such data are important and it is hoped will influence the decision to prescribe antivirals to patients hospitalized with influenza. Antiviral prescribing for influenza is suboptimal and is a major deficit in pandemic preparedness (in which antiviral prescribing will be a key component of response). Because randomized control trials in hospitalized patients with influenza are not feasible for ethical reasons, studies such as this one provide the best evidence of benefit and should be incorporated into routine clinical practice.
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