奥司他韦可加快流感样疾病的恢复
作者：
小柯机器人 发布时间：2019/12/16 17:48:37
英国牛津大学Christopher C Butler课题组的一项最新研究发现奥司他韦可加快流感样疾病的恢复。该研究2019年12月12日发表于国际一流学术期刊《The Lancet》杂志上。
欧洲流感样疾病的初级治疗中，很少开具抗病毒药物，因现实治疗中认为其无效，且那些特别受益的个体未在独立试验中进行确认。
2016年1月15日至2018年4月12日，研究组进行了一项开放性、实用性、适应性、随机对照试验，在15个欧洲国家的三个流感季招募了3266名1岁及以上的参与者，将其按1：1随机分组，其中1629名进行常规治疗+奥司他韦治疗，1637名进行常规治疗。
最终有3059名参与者完成试验，有1590名（52%）经PCR证实为流感。奥司他韦组的所有参与者和36个预先指定亚组中30个组的参与者恢复时间较短。
奥司他韦的估计绝对平均受益时间为1.02天，在预先指定的亚组中，12岁以下症状较轻、无合并症的参与者绝对平均受益时间为0.70天，65岁及以上有更严重疾病、合并症和更长病史的参与者其病程缩短3.2天。但奥司他韦组更容易发生恶心与呕吐。
总之，流感样疾病初级治疗患者采用奥司他韦治疗可比仅常规治疗早康复一天。伴有合并症、症状持续时间较长的年老、病情较重的患者可提早恢复2-3天。
附：英文原文
Title: Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial
Author: Christopher C Butler, Alike W van der Velden, Emily Bongard, Benjamin R Saville, Jane Holmes, Samuel Coenen, Johanna Cook, Nick A Francis, Roger J Lewis, Maciek Godycki-Cwirko, Carl Llor, Sawomir Chlabicz, Christos Lionis, Bohumil Seifert, Pr-Daniel Sundvall, Annelies Colliers, Rune Aabenhus, Lars Bjerrum, Nicolay Jonassen Harbin, Morten Lindbk, Dominik Glinz, Heiner C Bucher, Bernadett Kovács, Ruta Radzeviciene Jurgute, Pia Touboul Lundgren, Paul Little, Andrew W Murphy, An De Sutter, Peter Openshaw, Menno D de Jong, Jason T Connor, Veerle Matheeussen, Margareta Ieven, Herman Goossens, Theo J Verheij
Issue&Volume: December 12, 2019
Abstract:
Background
Antivirals are infrequently prescribed in European primary care for influenza-like illness, mostly because of perceived ineffectiveness in real world primary care and because individuals who will especially benefit have not been identified in independent trials. We aimed to determine whether adding antiviral treatment to usual primary care for patients with influenza-like illness reduces time to recovery overall and in key subgroups.
Methods
We did an open-label, pragmatic, adaptive, randomised controlled trial of adding oseltamivir to usual care in patients aged 1 year and older presenting with influenza-like illness in primary care. The primary endpoint was time to recovery, defined as return to usual activities, with fever, headache, and muscle ache minor or absent. The trial was designed and powered to assess oseltamivir benefit overall and in 36 prespecified subgroups defined by age, comorbidity, previous symptom duration, and symptom severity, using a Bayesian piece-wise exponential primary analysis model. The trial is registered with the ISRCTN Registry, number ISRCTN 27908921.
Findings
Between Jan 15, 2016, and April 12, 2018, we recruited 3266 participants in 15 European countries during three seasonal influenza seasons, allocated 1629 to usual care plus oseltamivir and 1637 to usual care, and ascertained the primary outcome in 1533 (94%) and 1526 (93%). 1590 (52%) of 3059 participants had PCR-confirmed influenza infection. Time to recovery was shorter in participants randomly assigned to oseltamivir (hazard ratio 1·29, 95% Bayesian credible interval [BCrI] 1·20–1·39) overall and in 30 of the 36 prespecified subgroups, with estimated hazard ratios ranging from 1·13 to 1·72. The estimated absolute mean benefit from oseltamivir was 1·02 days (95% [BCrI] 0·74–1·31) overall, and in the prespecified subgroups, ranged from 0·70 (95% BCrI 0·30–1·20) in patients younger than 12 years, with less severe symptoms, no comorbidities, and shorter previous illness duration to 3·20 (95% BCrI 1·00–5·50) in patients aged 65 years or older who had more severe illness, comorbidities, and longer previous illness duration. Regarding harms, an increased burden of vomiting or nausea was observed in the oseltamivir group.
Interpretation
Primary care patients with influenza-like illness treated with oseltamivir recovered one day sooner on average than those managed by usual care alone. Older, sicker patients with comorbidities and longer previous symptom duration recovered 2–3 days sooner.
DOI: 10.1016/S0140-6736(19)32982-4
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32982-4/fulltext
