tetano
Editor, Senior Moderator
PLoS One. 2019 Nov 7;14(11):e0224683. doi: 10.1371/journal.pone.0224683. eCollection 2019. [h=1]Effectiveness of four types of neuraminidase inhibitors approved in Japan for the treatment of influenza.[/h]
Mawatari M[SUP]1[/SUP], Saito R[SUP]1[/SUP], Hibino A[SUP]1[/SUP], Kondo H[SUP]1[/SUP], Yagami R[SUP]1[/SUP], Odagiri T[SUP]1,[/SUP][SUP]2[/SUP], Tanabe I[SUP]1[/SUP], Shobugawa Y[SUP]1[/SUP]; Japanese Influenza Collaborative Study Group.
[h=3]Author information[/h] 1 Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 2 Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Iwate, Japan.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Neuraminidase inhibitors (NAIs) effectively treat influenza. The clinical effectiveness of four NAIs (oseltamivir, zanamivir, laninamivir, and peramivir) was evaluated against influenza A/H1N1pdm09, A/H3N2, and B viruses. Additionally, fever duration in patients infected with oseltamivir-resistant influenza A/H1N1pdm09 with the H275Y mutation was evaluated.
[h=4]METHODS:[/h] Patients aged <20 years who visited outpatient clinics in Japan with influenza-like illnesses were enrolled during 4 influenza seasons from 2012/2013 to 2015/2016. After obtaining informed consent, patients who tested positive for influenza with rapid tests received one of the four NAIs. Patients recorded their body temperature daily for 8 days from the first visit. The influenza strain was identified using real-time polymerase chain reaction. Univariate and multivariable analyses were used to evaluate factors influencing fever duration. In children aged ≤5 years treated with oseltamivir, fever duration in oseltamivir-resistant A/H1N1pdm09-infected patients was compared to that in oseltamivir-sensitive A/H1N1pdm09-infected patients.
[h=4]RESULTS:[/h] Of the 1,368 patients analyzed, 297 (21.7%), 683 (49.9%), and 388 (28.4%) were infected with influenza A/H1N1pdm09, A/H3N2, and B, respectively. In multivariable analysis factors associated with significantly prolonged fever duration included: treatment with laninamivir (hazard ratio
: 0.78, p = 0.006, compared to oseltamivir), influenza B (HR: 0.58, p<0.001, compared to influenza A/H1N1pdm09), and a higher body temperature at the clinic visit (HR: 0.87 per degree Celsius, p<0.001). Increasing age was associated with a significantly shorter duration of fever (HR: 1.31 for 6-9 years old, p<0.001; and HR: 1.65 for 10-19 years old, p<0.001, respectively, compared to 0-5 years old). Following treatment with oseltamivir, fever duration was significantly longer for oseltamivir-resistant A/H1N1pdm09-infected patients (n = 5) than for oseltamivir-sensitive A/H1N1pdm09 infected patients (n = 111) (mean, 89 versus 40 hours, p<0.001).
[h=4]CONCLUSIONS:[/h] Our results revealed characteristic information on the effectiveness of the four NAIs and also on oseltamivir-resistant viruses that may affect patients' clinical care.
PMID: 31697721 DOI: 10.1371/journal.pone.0224683
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Mawatari M[SUP]1[/SUP], Saito R[SUP]1[/SUP], Hibino A[SUP]1[/SUP], Kondo H[SUP]1[/SUP], Yagami R[SUP]1[/SUP], Odagiri T[SUP]1,[/SUP][SUP]2[/SUP], Tanabe I[SUP]1[/SUP], Shobugawa Y[SUP]1[/SUP]; Japanese Influenza Collaborative Study Group.
[h=3]Author information[/h] 1 Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 2 Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Iwate, Japan.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Neuraminidase inhibitors (NAIs) effectively treat influenza. The clinical effectiveness of four NAIs (oseltamivir, zanamivir, laninamivir, and peramivir) was evaluated against influenza A/H1N1pdm09, A/H3N2, and B viruses. Additionally, fever duration in patients infected with oseltamivir-resistant influenza A/H1N1pdm09 with the H275Y mutation was evaluated.
[h=4]METHODS:[/h] Patients aged <20 years who visited outpatient clinics in Japan with influenza-like illnesses were enrolled during 4 influenza seasons from 2012/2013 to 2015/2016. After obtaining informed consent, patients who tested positive for influenza with rapid tests received one of the four NAIs. Patients recorded their body temperature daily for 8 days from the first visit. The influenza strain was identified using real-time polymerase chain reaction. Univariate and multivariable analyses were used to evaluate factors influencing fever duration. In children aged ≤5 years treated with oseltamivir, fever duration in oseltamivir-resistant A/H1N1pdm09-infected patients was compared to that in oseltamivir-sensitive A/H1N1pdm09-infected patients.
[h=4]RESULTS:[/h] Of the 1,368 patients analyzed, 297 (21.7%), 683 (49.9%), and 388 (28.4%) were infected with influenza A/H1N1pdm09, A/H3N2, and B, respectively. In multivariable analysis factors associated with significantly prolonged fever duration included: treatment with laninamivir (hazard ratio
: 0.78, p = 0.006, compared to oseltamivir), influenza B (HR: 0.58, p<0.001, compared to influenza A/H1N1pdm09), and a higher body temperature at the clinic visit (HR: 0.87 per degree Celsius, p<0.001). Increasing age was associated with a significantly shorter duration of fever (HR: 1.31 for 6-9 years old, p<0.001; and HR: 1.65 for 10-19 years old, p<0.001, respectively, compared to 0-5 years old). Following treatment with oseltamivir, fever duration was significantly longer for oseltamivir-resistant A/H1N1pdm09-infected patients (n = 5) than for oseltamivir-sensitive A/H1N1pdm09 infected patients (n = 111) (mean, 89 versus 40 hours, p<0.001).
[h=4]CONCLUSIONS:[/h] Our results revealed characteristic information on the effectiveness of the four NAIs and also on oseltamivir-resistant viruses that may affect patients' clinical care.
PMID: 31697721 DOI: 10.1371/journal.pone.0224683
Free full text