Factors associated with clinical and virological response in patients treated with oseltamivir or zanamivir for influenza A during the 2008–2009 winter

Oseltamivir or zanamivir are effective in outpatients with seasonal influenza; however, factors associated with response have been incompletely described. During the 2008/2009 epidemic, in a randomized trial for influenza A-infected outpatients, clinical (time to alleviation of flu-related symptoms)...

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Bibliographic Details
Published in:	Clinical microbiology and infection Vol. 19; no. 2; pp. 196 - 203
Main Authors:	Blanchon, T., Mentré, F., Charlois-Ou, C., Domic, Q., Mosnier, A., Bouscambert, M., Carrat, F., Duval, X., Enouf, V., Leport, C., Bivir Study Group
Format:	Journal Article
Language:	English
Published:	Oxford, UK Elsevier Ltd 01-02-2013 Blackwell Publishing Ltd Elsevier Limited Elsevier for the European Society of Clinical Microbiology and Infectious Diseases
Subjects:	Adolescent Adult Age Age Factors Aged Anti-Bacterial Agents - therapeutic use Antibiotics Antiretroviral drugs Antiviral Agents - therapeutic use Clinical trials Epidemics Epidemiological factors Exo- alpha -sialidase Female Gender HIV Human immunodeficiency virus Humans Influenza A Influenza, Human - drug therapy Influenza, Human - pathology Influenza, Human - virology Life Sciences Male Microbiology and Parasitology Middle Aged Multivariate analysis neuraminidase inhibitors Oseltamivir Oseltamivir - therapeutic use Sampling seasonal influenza Severity of Illness Index Treatment Outcome Viral Load Young Adult Zanamivir Zanamivir - therapeutic use Epidemiological factors neuraminidase inhibitors gender seasonal influenza treatment outcome
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Summary:	Oseltamivir or zanamivir are effective in outpatients with seasonal influenza; however, factors associated with response have been incompletely described. During the 2008/2009 epidemic, in a randomized trial for influenza A-infected outpatients, clinical (time to alleviation of flu-related symptoms) and virological (rate of patients with day 2 nasal viral load <200 cgeq/µL) responses to oseltamivir or zanamivir were assessed and associated factors were determined using multivariate analysis. For oseltamivir (141 patients) and zanamivir (149 patients) median times to alleviation of symptoms were 3 and 4 days, respectively; 59% and 34% had virological response. For oseltamivir, a lower clinical response was associated with female gender (HR, 0.53; 95% CI, 0.36–0.79), baseline symptoms score >14 (HR, 0.47; 0.32–0.70), viral load ≥5 log cgeq/µL (HR, 0.63; 0.43–0.93), and initiation of antibiotics (HR, 0.30; 0.12–0.76); a lower virological response was associated with female gender (OR, 0.45; 0.21–0.96), baseline viral load ≥5 log cgeq/µL (OR, 0.40; 0.20–0.84) and days 0–2 incomplete compliance (OR, 0.31; 0.10–0.98). For zanamivir, virological response was associated with age ≥50 years (OR, 0.29; 0.10–0.85) and initiation of antibiotics at baseline (OR, 4.24; 1.07–17.50). Factors associated with lower response to neuraminidase inhibitors in outpatients appeared to be easily identifiable during routine clinical examination and, when appropriate, by nasal sampling at baseline. The unknown association between gender and response to oseltamivir was not explained by compliance.
Bibliography:	The Bivir Study Group members are in Appendix 1. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1198-743X 1469-0691
DOI:	10.1111/j.1469-0691.2011.03751.x