Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis
Background: While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the i...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Published: |
Oxford University Press
2017
|
| Subjects: | |
| Online Access: | https://eprints.nottingham.ac.uk/40623/ |
| _version_ | 1848796101463769088 |
|---|---|
| author | Venkatesan, Sudhir Myles, Puja R. Leonardi-Bee, Jo Muthuri, Stella G. Al Masri, Malak Andrews, Nick Bantar, Carlos Dubnov-Raz, Gal Gérardin, Patrick Koay, Evelyn S.C. Loh, Tze Ping Memish, Ziad A. Miller, Elizabeth Oliva, Maria E. Rath, Barbara A. Schweiger, Brunhilde Tang, Julian W. Tran, Dat Vidmar, Tjasa Waight, Pauline A. Nguyen-Van-Tam, Jonathan S. |
| author_facet | Venkatesan, Sudhir Myles, Puja R. Leonardi-Bee, Jo Muthuri, Stella G. Al Masri, Malak Andrews, Nick Bantar, Carlos Dubnov-Raz, Gal Gérardin, Patrick Koay, Evelyn S.C. Loh, Tze Ping Memish, Ziad A. Miller, Elizabeth Oliva, Maria E. Rath, Barbara A. Schweiger, Brunhilde Tang, Julian W. Tran, Dat Vidmar, Tjasa Waight, Pauline A. Nguyen-Van-Tam, Jonathan S. |
| author_sort | Venkatesan, Sudhir |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection.
Methods: We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including “study center” as a random intercept to account for differences in baseline hospitalization rate between centers.
Results: We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20–0.30).
Conclusions: In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment. |
| first_indexed | 2025-11-14T19:42:38Z |
| format | Article |
| id | nottingham-40623 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:42:38Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-406232020-05-04T18:35:05Z https://eprints.nottingham.ac.uk/40623/ Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis Venkatesan, Sudhir Myles, Puja R. Leonardi-Bee, Jo Muthuri, Stella G. Al Masri, Malak Andrews, Nick Bantar, Carlos Dubnov-Raz, Gal Gérardin, Patrick Koay, Evelyn S.C. Loh, Tze Ping Memish, Ziad A. Miller, Elizabeth Oliva, Maria E. Rath, Barbara A. Schweiger, Brunhilde Tang, Julian W. Tran, Dat Vidmar, Tjasa Waight, Pauline A. Nguyen-Van-Tam, Jonathan S. Background: While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection. Methods: We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including “study center” as a random intercept to account for differences in baseline hospitalization rate between centers. Results: We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20–0.30). Conclusions: In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment. Oxford University Press 2017-02-12 Article PeerReviewed Venkatesan, Sudhir, Myles, Puja R., Leonardi-Bee, Jo, Muthuri, Stella G., Al Masri, Malak, Andrews, Nick, Bantar, Carlos, Dubnov-Raz, Gal, Gérardin, Patrick, Koay, Evelyn S.C., Loh, Tze Ping, Memish, Ziad A., Miller, Elizabeth, Oliva, Maria E., Rath, Barbara A., Schweiger, Brunhilde, Tang, Julian W., Tran, Dat, Vidmar, Tjasa, Waight, Pauline A. and Nguyen-Van-Tam, Jonathan S. (2017) Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis. Clinical Infectious Diseases . ISSN 1537-6591 Influenza Neuraminidase inhibitors Individual participant data meta-analyses Hospitalization Pandemic https://academic.oup.com/cid/article/2990224/Impact doi:10.1093/cid/cix127 doi:10.1093/cid/cix127 |
| spellingShingle | Influenza Neuraminidase inhibitors Individual participant data meta-analyses Hospitalization Pandemic Venkatesan, Sudhir Myles, Puja R. Leonardi-Bee, Jo Muthuri, Stella G. Al Masri, Malak Andrews, Nick Bantar, Carlos Dubnov-Raz, Gal Gérardin, Patrick Koay, Evelyn S.C. Loh, Tze Ping Memish, Ziad A. Miller, Elizabeth Oliva, Maria E. Rath, Barbara A. Schweiger, Brunhilde Tang, Julian W. Tran, Dat Vidmar, Tjasa Waight, Pauline A. Nguyen-Van-Tam, Jonathan S. Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title_full | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title_fullStr | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title_full_unstemmed | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title_short | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| title_sort | impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza a(h1n1)pdm09 at high risk of hospitalization: an individual participant data (ipd) meta-analysis |
| topic | Influenza Neuraminidase inhibitors Individual participant data meta-analyses Hospitalization Pandemic |
| url | https://eprints.nottingham.ac.uk/40623/ https://eprints.nottingham.ac.uk/40623/ https://eprints.nottingham.ac.uk/40623/ |