Antivirals for flu. Better late than never?

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Category: Antivirals • Bird flu

Posted on: November 15, 2007 7:29 AM, by revere 

If you are in the "older age group" (as those of us in that group prefer to be called) you are at increased risk of dying from seasonal influenza (pandemic strains seem to target the young), but you are also less likely to be helped by a flu shot because you don't mount as fast and effective an immune response. At least that's what we think on the basis of current evidence. Like everything else about flu, it's subject to change. 

Like the idea that you have a 48 hour window for the use of antiviral neuraminidase inhibitors like tamiflu. After 48 hours, we believed, they don't do any good. Maybe that's true, but some new evidence suggests it isn't:

People stricken with a case of flu so severe it sent them to hospital were five times less likely to die if they were put on antiviral therapy compared to those who didn't receive one of these drugs, the study found. 

The findings could alter the way doctors treat hospitalized flu patients, experts who were not involved with the study said.

"I think and talk about flu a lot. And this is going to change what I say," said Dr. Anne Moscona, an infectious diseases expert at Weill Cornell Medical Center in New York City.

"It's clear from this experience now that there seems to be benefit even with later treatment," Dr. Frederick Hayden, an antiviral expert with the World Health Organization's global influenza program, said from Geneva.

Hayden said the study will "add to the body of evidence . . . that hospitalized patients warrant therapy if there's evidence for ongoing (virus) replication."

The study evaluated what happened to 327 adults who were hospitalized with influenza in a network of south-central Ontario hospitals during the 2004-05 and 2005-06 flu seasons. The work was led by researchers at Mount Sinai Hospital and the University Health Network, both in Toronto. (Helen Branswell, Canadian Press)

Maybe it's clear to dr. Hayden, but I don't know that yet. Unfortunately this otherwise informative article doesn't say where the work was published or otherwise described, so I can't say much more about its methods. The study subjects as a whole were high risk because of their age and other medical conditions. All were said to have tested positive for infection with influenza A, but it was not a randomized trial because of the ethical issue of withholding a drug thought effective, so it remains possible those treated with antivirals (32%) at the discretion of their physicians were different in important ways that affected their survival from those not treated. Without the details it is hard to say more, and it is likely even with the details we will have to consider this another data point, although an important one. 

If you are in the "older age group" it is not bad news and these days I am glad to settle for news that's not bad, even if I don't know yet if it is really good.

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Pebbles19 Members Profile Send Private Message Find Members Posts Add to Buddy List Valued Member Joined: August 01 2007 Status: Offline Points: 232	Post Options Post Reply Quote Pebbles19 Report Post Thanks(0) Quote Reply Topic: Antivirals for flu. Better late than never? Posted: November 15 2007 at 11:07am
	Antivirals for flu. Better late than never? Category: Antivirals • Bird flu Posted on: November 15, 2007 7:29 AM, by revere If you are in the "older age group" (as those of us in that group prefer to be called) you are at increased risk of dying from seasonal influenza (pandemic strains seem to target the young), but you are also less likely to be helped by a flu shot because you don't mount as fast and effective an immune response. At least that's what we think on the basis of current evidence. Like everything else about flu, it's subject to change. Like the idea that you have a 48 hour window for the use of antiviral neuraminidase inhibitors like tamiflu. After 48 hours, we believed, they don't do any good. Maybe that's true, but some new evidence suggests it isn't: People stricken with a case of flu so severe it sent them to hospital were five times less likely to die if they were put on antiviral therapy compared to those who didn't receive one of these drugs, the study found. The findings could alter the way doctors treat hospitalized flu patients, experts who were not involved with the study said. "I think and talk about flu a lot. And this is going to change what I say," said Dr. Anne Moscona, an infectious diseases expert at Weill Cornell Medical Center in New York City. "It's clear from this experience now that there seems to be benefit even with later treatment," Dr. Frederick Hayden, an antiviral expert with the World Health Organization's global influenza program, said from Geneva. Hayden said the study will "add to the body of evidence . . . that hospitalized patients warrant therapy if there's evidence for ongoing (virus) replication." The study evaluated what happened to 327 adults who were hospitalized with influenza in a network of south-central Ontario hospitals during the 2004-05 and 2005-06 flu seasons. The work was led by researchers at Mount Sinai Hospital and the University Health Network, both in Toronto. (Helen Branswell, Canadian Press) Maybe it's clear to dr. Hayden, but I don't know that yet. Unfortunately this otherwise informative article doesn't say where the work was published or otherwise described, so I can't say much more about its methods. The study subjects as a whole were high risk because of their age and other medical conditions. All were said to have tested positive for infection with influenza A, but it was not a randomized trial because of the ethical issue of withholding a drug thought effective, so it remains possible those treated with antivirals (32%) at the discretion of their physicians were different in important ways that affected their survival from those not treated. Without the details it is hard to say more, and it is likely even with the details we will have to consider this another data point, although an important one. If you are in the "older age group" it is not bad news and these days I am glad to settle for news that's not bad, even if I don't know yet if it is really good.
	hugs :o)