Early Oseltamivir Therapy for Adults Hospitalized with Influenza A

Early Oseltamivir Therapy for Adults Hospitalized with Influenza A

Authors: Nathaniel M. Lewis, Elizabeth J. Harker, Lauren B. Grant, et al.
Journal: Clinical Infectious Diseases, 2024

Conclusion:

  • Early oseltamivir therapy on the day of hospital admission significantly reduces:

    • Pulmonary disease progression.

    • Need for ICU care and organ support.

    • In-hospital mortality.

  • These findings highlight the importance of timely antiviral treatment to improve outcomes in adults hospitalized with influenza.

Methods:

  • Study Design: Multicenter observational study conducted at 24 U.S. hospitals from October 2022 to July 2023.

  • Participants: Adults (≥18 years) hospitalized with laboratory-confirmed influenza A.

  • Intervention: Oseltamivir therapy initiated on the day of admission versus late initiation or no treatment.

  • Primary Outcome: Peak pulmonary disease severity categorized as:

    • No oxygen support

    • Standard supplemental oxygen

    • High-flow oxygen/non-invasive ventilation

    • Invasive mechanical ventilation

    • Death

  • Secondary Outcomes:

    • ICU admission

    • Use of acute kidney replacement therapy or vasopressors

    • In-hospital mortality

  • Analysis: Adjusted multivariable models to account for admission-day severity, age, sex, vaccination status, and site.

Results:

Cohort Characteristics:

  • Total Patients Analyzed: 840

    • Early Treatment Group: 415 (49%)

    • Late/No Treatment Group: 425 (51%)

Primary Outcome:

  • Early treatment with oseltamivir was associated with lower peak pulmonary disease severity:

    • Adjusted odds ratio (aOR): 0.60 (95% CI: 0.49–0.72).

Secondary Outcomes:

  1. ICU Admission:

    • Reduced odds with early treatment: aOR: 0.24 (95% CI: 0.13–0.47).

  2. Acute Kidney Replacement Therapy or Vasopressor Use:

    • Lower risk in early treatment group: aOR: 0.40 (95% CI: 0.22–0.67).

  3. In-Hospital Mortality:

    • Significantly reduced mortality: aOR: 0.36 (95% CI: 0.18–0.72).

Lewis, N.M., Harker, E.J., Grant, L.B., Zhu, Y., Grijalva, C.G., Chappell, J.D., Rhoads, J.P., Baughman, A., Casey, J.D., Blair, P.W. and Jones, I.D., 2024. Benefit of early oseltamivir therapy for adults hospitalized with influenza A: an observational study. Clinical Infectious Diseases, p.ciae584.

 

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