The article by Lehnert et al. (1) has left me, as a primary care provider for the treatment, quite perplexed:
Despite the excessive mortality due to influenza viruses, of 20 000/year in Germany (www.rki.de/SharedDocs/FAQ/Influenza/FAQ_Liste.html), it has still somehow not been possible to carry out studies with the required number of participants.
Thus, I am supposed to use neuraminidase inhibitors for patients for whom efficacy has not been demonstrated (for instance, pregnant women and immunosuppressed patients).
In fact, eTable 2 even shows that there is no reduction of disease duration for elderly patients, yet I am expected to still treat them.
The risk–benefit ratio of the antiviral therapy is believed to be good, based on a reduction of bronchitis and “patient-perceived pneumonia” in a patient group that I do not treat (healthy adults).
Finally, even though the studies show that neuraminidase inhibitors hardly are effective, I should still use them because there are no other therapeutic alternatives. This contradicts the requirements of our health insurance system for diseases where no therapeutic alternatives exist. Further, the study by Muthuri et al. (2), which states that mortality decreases when using neuraminidase inhibitors, was strongly criticized for its statistical methods (3, 4).
From 2005–2009, approximately 330 million euros of public funds were spent only in Germany on neuraminidase inhibitors, which were first stored and then destroyed.
Faced with these facts, what advice should I give to my patients? Unfortunately, I remain at a loss on this subject. I would like to protect my patients, but I do not feel that I can recommend these drugs to them or to our society in general.
Dr. med. Thomas Maibaum
Praxis für Allgemeinmedizin, Rostock, Germany
|1.||Lehnert R, Pletz M, Reuss A, Schaberg T: Antiviral medications in seasonal and pandemic influenza—a systematic review. Dtsch Arztebl Int 2016; 113: 799–807 VOLLTEXT|
|2.||Muthuri SG, Venkatesan S, Myles PR, et al.: Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med 2014; 2: 395–404 CrossRef|
|3.||Kmietowicz Z: Study claiming Tamiflu saved lives was based on „flawed“ analysis. BMJ 2014; 348: g2228 CrossRef MEDLINE|
|4.||Jones M: Mark Jones’s reply to Myles and Leonardi-Bee’s response to his critique of their paper reported in The BMJ. BMJ 2014; 348: g3001 CrossRef MEDLINE|