Oseltamivir plus usual primary care shortens time to recovery in influenza

Takeaway

• Adding oseltamivir to usual primary care for influenza-like illness (ILI) shortens recovery time.

Why this matters

• Offer antiviral treatment to at-risk, other patients with ILI who might benefit from slightly fewer recovery days.

Key results

• 3259 (1635 control, 1624 intervention) with confirmed influenza included.
• 96% (1477) initiated treatment, 80% (657) with confirmed influenza completed course.
• Time to recovery, intent-to-treat usual care patients=6.73 (95% Bayesian credible interval [BCrI], 6.50-6.96) days vs 5.71 (BCrI, 5.2-6.2) days intervention.
• Overall oseltamivir benefit=1.02 (BCrI, 0.74-1.31) days; HR: 1.29 (95% BCrI, 1.20-1.39). 
• Estimated HRs for marginal subgroups ranged from 1.26 to 1.41.
• Estimated HR for patients aged ≥65, with comorbidities, moderate-severe symptoms, previous symptom duration >48 hours: 1.38-1.52 (oseltamivir benefit=2.30-3.20 days vs usual 11-13 days to recover).
• New/worsening vomiting/nausea occurred in 21% (325) intervention vs 16% (248) usual care patients and lasted longer (HR time to symptom alleviation, 0.94; 95% CI, 0.86-1.01).

Study design

• Open-label, pragmatic, randomised controlled study assessing oseltamivir (75 mg po bid q5d or 30, 60, or 75 mg oral suspension bid q5d) plus usual primary care for ILI over 3 seasons (2015-2016, 2016-2017, 2017-2018).
• Funding: European Commission’s Seventh Framework Programme.

Limitations

• Open-label.
• Children, elderly underrepresented.
• Missing cases.