It’s that season of the year again, and with the fatalities from the H1N1 strain returning to the news folks are clamoring for Tamiflu (oseltamivir).
And, there’s still no evidence it has any protective effect at reducing complications from seasonal influenza. In these two studies, a systematic review and a meta-analysis, some small reductions in symptom duration in mild illness were outweighed by drug adverse events such as nausea, vomiting, and diarrhea. There is no evidence of any decrease in severe complications of influenza.
Unfortunately, the heterogeneity of trials, irregularities in baseline characteristics, and incomplete peer review all impair knowledge translation of this relatively expensive outpatient medication. You’re all hopefully aware of the BMJ’s ongoing open data campaign regarding Tamiflu. The last update from July seemed to indicate independent access to higher-quality trial data had finally been achieved. If there is a durable, beneficial effect attributable to osletamivir, perhaps we will soon know. Given the lack of transparency to date, I’m not optimistic.
“The value of neuraminidase inhibitors for the prevention and treatment of seasonal influenza: a systematic review of systematic reviews.”
http://www.ncbi.nlm.nih.gov/pubmed/23565231
“Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials.”
http://www.ncbi.nlm.nih.gov/pubmed/22997224
Tamiflu CAN BE effective in ameliorating both the symptoms and total length of course in Influenza A&B….. But, only if started within 48-72 hours of sx onset….the sooner it is started the better,and I have never rx'd it for anyone with sx's lasting longer than 72 hrs…..
I would say Tamiflu MAY be effective … with the same caveat that it MAY NOT be effective. Roche's reluctance to share its data for independent review makes me, and many others, highly skeptical it confers any substantial benefit.
I do not offer it to patients. If for some reason my medical director forced me to, I would inform patients Tamiflu was a *controversial* medication with low-quality, biased evidence from the manufacturer suggesting one day's relief of symptoms if started early in the disease course, and that mild, but unpleasant, side effects occurred in ~30% of patients. And it costs >$100.