Department of International Health, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
J Infect Chemother. 2012 Dec;18(6):858-64. doi: 10.1007/s10156-012-0428-1. Epub 2012 May 29.
The clinical effectiveness of the newly released neuraminidase inhibitors (NAIs) laninamivir and peramivir has not been sufficiently evaluated in influenza-infected patients in clinical and practical settings. In this study, we analyzed the clinical data of 211 patients infected with influenza A virus subtype H3N2 (A(H3N2)) and 45 patients infected with influenza A virus subtype H1N1pdm (A(H1N1)pdm09) who received the NAIs oseltamivir, zanamivir, laninamivir, or peramivir during the 2010-2011 influenza season. The duration of fever from the first dose of the NAI to fever alleviation to <37.5 °C was evaluated as an indicator of the clinical effectiveness of the NAIs in the influenza-infected patients. For the A(H3N2)-infected patients, Kaplan-Meier analysis showed the peramivir treatment group had the fastest time of fever alleviation to <37.5 °C (median 17.0 h, 95 % confidence interval [CI] 7.2-26.8 h) of the four treatment groups. No significant difference was found in the time to fever alleviation among the other antivirals, oseltamivir, zanamivir, and laninamivir. Results of multivariate analysis, using a Cox proportional-hazards model (hazard ratio 3.321) adjusted for the factors age, sex, body weight, vaccination status, time from onset to the clinic visit, and body temperature showed significantly faster fever alleviation in the peramivir treatment group compared with the oseltamivir treatment group. For the A(H1N1)pdm09-infected patients, only the oseltamivir and zanamivir treatment groups were compared, and no significant difference in time to alleviation of fever was observed between the two groups. Based on a cycling probe real-time polymerase chain reaction (PCR) assay, none of the A(H1N1)pdm09 strains in this study had the H275Y mutation conferring oseltamivir resistance. Further evaluation of the clinical effectiveness of the newly released NAIs for influenza-infected patients, including those infected with A(H1N1)pdm09, is needed.
新上市的神经氨酸酶抑制剂(NAI)拉尼米韦和帕拉米韦在临床和实际环境中对流感感染患者的临床疗效尚未得到充分评估。本研究分析了 211 例感染 H3N2 亚型流感病毒(A(H3N2))和 45 例感染甲型 H1N1 流感病毒(A(H1N1)pdm09)的患者的临床数据,这些患者在 2010-2011 流感季节接受了 NAI 奥司他韦、扎那米韦、拉尼米韦或帕拉米韦治疗。从 NAI 首次给药到发热缓解至 <37.5°C 的发热持续时间被评估为 NAI 治疗流感感染患者的临床疗效指标。对于感染 A(H3N2)的患者,Kaplan-Meier 分析显示帕拉米韦治疗组发热缓解至 <37.5°C 的时间最快(中位数 17.0 h,95%置信区间 [CI] 7.2-26.8 h)。在其他抗病毒药物(奥司他韦、扎那米韦和拉尼米韦)中,发热缓解时间无显著差异。多变量分析结果,使用 Cox 比例风险模型(风险比 3.321),根据年龄、性别、体重、疫苗接种状态、发病至就诊时间和体温等因素进行调整,显示帕拉米韦治疗组发热缓解时间明显快于奥司他韦治疗组。对于感染 A(H1N1)pdm09 的患者,仅比较了奥司他韦和扎那米韦治疗组,两组发热缓解时间无显著差异。基于循环探针实时聚合酶链反应(PCR)检测,本研究中没有 A(H1N1)pdm09 株具有奥司他韦耐药性的 H275Y 突变。需要进一步评估新上市的 NAI 对流感感染患者(包括感染 A(H1N1)pdm09 的患者)的临床疗效。