McMaster University, Hamilton, Ontario, Canada.
Ann Intern Med. 2012 Apr 3;156(7):512-24. doi: 10.7326/0003-4819-156-7-201204030-00411. Epub 2012 Feb 27.
Systematic reviews of randomized, controlled trials in patients with influenza suggest a lack of evidence about the effects of antiviral therapy on several patient-important outcomes of influenza.
To systematically review observational studies for benefits and harms of oseltamivir, zanamivir, amantadine, or rimantadine in the treatment of influenza.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, SIGLE, the Chinese Biomedical Literature Database, Panteleimon, and LILACS up to November 2010; contact with pharmaceutical companies; and reference lists.
Observational studies in any language that compared single antiviral therapy with no therapy or other antiviral therapy, or that had no comparator, for influenza or influenza-like illness.
Two independent investigators extracted data. Confidence in the estimates of the obtained effects (quality of evidence) was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.
74 studies fulfilled the inclusion criteria. Meta-analyses of the few studies providing effects with adjustment for confounders suggest that, in high-risk populations, oral oseltamivir may reduce mortality (odds ratio, 0.23 [95% CI, 0.13 to 0.43]; low-quality evidence), hospitalization (odds ratio, 0.75 [CI, 0.66 to 0.89]; low-quality evidence), and duration of symptoms (33 hours [CI, 21 to 45 hours]; very low-quality evidence) compared with no treatment. Earlier treatment with oseltamivir was generally associated with better outcomes. Inhaled zanamivir may lead to shorter symptom duration (23 hours [CI, 17 to 28 hours]; moderate-quality evidence) and fewer hospitalizations (odds ratio, 0.66 [CI, 0.37 to 1.18]) but more complications than no treatment. Direct comparison of oral oseltamivir and inhaled zanamivir suggests no important differences in key outcomes. Data from 1 study suggest that oral amantadine may reduce mortality and pneumonia associated with influenza A. No included study evaluated rimantadine.
Mortality was assessed in high-risk patients, and generalizability is limited. The overall body of evidence is limited by risk for confounding and selection, reporting, and publication bias.
Therapy with oral oseltamivir and inhaled zanamivir may provide a net benefit over no treatment of influenza. However, as with the randomized trials, the confidence in the estimates of the effects for decision making is low to very low. PRIMARY FUNDING SOURCES: World Health Organization and McMaster University.
系统评价提示，随机对照试验在流感患者中缺乏关于抗病毒治疗对流感患者几个重要结局的证据。
系统评价奥司他韦、扎那米韦、金刚烷胺和金刚乙胺治疗流感的疗效和安全性。
检索 MEDLINE、EMBASE、Cochrane 对照试验中心注册库、CINAHL、SIGLE、中国生物医学文献数据库、Panteleimon 和 LILACS，检索时限截至 2010 年 11 月；联系制药公司；查阅参考文献。
不论语言，纳入比较单种抗病毒治疗与无治疗或其他抗病毒治疗，或无对照组的流感或流感样疾病的观察性研究。
两名独立的调查人员提取资料。采用 Grading of Recommendations Assessment，Development，and Evaluation 方法评估获得的效果（证据质量）的可信度。
74 项研究符合纳入标准。对少数经混杂因素校正后提供治疗效果的研究进行的 meta 分析提示，在高危人群中，口服奥司他韦可降低病死率（比值比，0.23[95%CI，0.13 至 0.43]；低质量证据）、住院率（比值比，0.75[CI，0.66 至 0.89]；低质量证据）和症状持续时间（33 小时[CI，21 至 45 小时]；极低质量证据），与无治疗相比。奥司他韦治疗开始越早，结局越好。吸入扎那米韦可能会缩短症状持续时间（23 小时[CI，17 至 28 小时]；中等质量证据）和住院率（比值比，0.66[CI，0.37 至 1.18]），但并发症更多，与无治疗相比。口服奥司他韦与吸入扎那米韦的直接比较提示，主要结局无显著差异。1 项研究的数据提示，口服金刚烷胺可能会降低流感相关病死率和肺炎。纳入的研究均未评价金刚乙胺。
病死率是在高危患者中评估的，推广性受限。总体证据受到混杂和选择、报告及发表偏倚的限制。
与无治疗相比，口服奥司他韦和吸入扎那米韦治疗流感可能会带来净获益。但是，与随机试验一样，对治疗效果的评估可信度为低至极低。
世界卫生组织和麦克马斯特大学。
