Thursday, January 19, 2012

Lies, Damned Lies, and Tamiflu (oseltamivir)

Receiving quite a bit of press yesterday, and rightfully so, the Cochrane Collaboration published their analysis of oseltamivir - the miracle influenza antiviral that (at great cost) is part of our nation's strategic stockpile for an influenza pandemic.  The story is interesting both regarding what they found, and what they didn't find.

As for the data from the review, the numbers are similar to what we've been basing our practice upon - oseltamivir significantly shortens the length of time until symptom improvement from 160 hours to 139 hours.  However, it did not demonstrate any difference in hospitalization rates.  Additionally - whether through study bias or by direct medication effects - the oseltamivir groups were significantly less likely to have a confirmed diagnosis of influenza.

So, this suggests that it's a little troubling that we've gone to all the expense to stockpile this expensive medication that does not appear to reduce hospitalizations from influenza - and it remains an individual decision whether that extra day of symptom improvement is worth exposure to the side effects of the medication.  But the reason this is national news is that Roche pharmaceuticals refused to supply the promised clinical data requested by the Cochrane Collaboration; the published analysis is based on 15 oseltamivir studies with complete information, and excludes 42 other studies with discrepancies in the data.  This sort of behavior is just another representative sample of the unethical, but completely understandable, profit-motivation of pharmaceutical corporations protecting their financial interests.

I would be greatly surprised if the clinical data Roche is holding onto supports oseltamivir efficacy.

"Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children - a review of clinical study reports"
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008965/abstract

"Flu Drugs: Search for evidence goes on"

1 comment:

  1. I have not read the full paper, but I don't see why any of this is a surprise.

    The best case before this was that symptoms would go away a day earlier with the drug.

    Drug resistance was occurring quickly.

    Take the drug and your symptoms might go away one day sooner, but you also might end up with a mutated strain of flu. Why is that better?

    Or get a flu shot and experience some local tissue irritation, but a dramatically decreased chance of developing any flu.

    Not just one day less, but no flu.

    Yes, for those not healthy enough for a flu shot and at risk for life-threatening complications, a drug that decreases symptoms even a little bit may be better, but that does not appear to be the target audience for the drug.

    Am I missing something about this?

    .

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