Oseltamivir didn't reduce hospitalization risk from influenza, did have adverse effects
A systematic review and meta-analysis of 15 randomized clinical trials found that oseltamivir was not associated with reduced risk of hospitalization compared with placebo and that nausea and vomiting were more common with the drug.
Oseltamivir was not associated with a reduced risk of hospitalization but was associated with an increase in gastrointestinal adverse events, a study found.
To assess the efficacy and safety of oseltamivir in preventing hospitalization among influenza-infected adult and adolescent outpatients, researchers reviewed 15 randomized clinical trials comparing oseltamivir to placebo or nonactive controls in outpatients with the flu. Results were published June 12 in JAMA Internal Medicine.
The intention-to-treat infected population included 6,295 patients. Of these, 54.7% received oseltamivir. The drug was not associated with any significant reduction in risk of hospitalization (risk ratio [RR], 0.77 [95% CI, 0.47 to 1.27]; risk difference [RD], −0.14% [95% CI, −0.32% to 0.16%]) or with hospitalization risk in patients with a mean age of 65 years or older (RR, 0.99; 95% CI, 0.19 to 5.13) or at greater risk of hospitalization (RR, 0.90; 95% CI, 0.37 to 2.17).
Within the subpopulation of the study analyzed for safety outcomes, oseltamivir was associated with increased nausea (RR, 1.43; 95% CI, 1.13 to 1.82) and vomiting (RR, 1.83; 95% CI, 1.28 to 2.63) but not serious adverse events (RR, 0.71; 95% CI, 0.46 to 1.08).
The study authors wrote that it “appeared unlikely that administration of oseltamivir to a general outpatient population had a meaningful effect on serious influenza-related outcomes culminating in hospitalization, although they added the caveat that the rate of hospitalization was exceedingly low (0.6% in the control group).
They cautioned that an adequately powered trial in a suitably high-risk population is needed to determine who might benefit from early treatment with oseltamivir to prevent hospitalization. “For oseltamivir to continue to be part of a viable influenza response with respect to preventing severe complications, future studies should focus on identifying the groups of higher-risk participants, with laboratory-confirmed influenza, who may derive benefit,” the authors wrote. “Conducting an adequately powered trial would require a large sample size; however, given millions have received oseltamivir, such a trial doesn't seem unreasonable.”