Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Gansu, China.
Influenza Other Respir Viruses. 2013 Sep;7 Suppl 2(Suppl 2):76-81. doi: 10.1111/irv.12085.
Despite the use of antivirals to treat patients with severe influenza, questions remain with respect to effects and safety. Although a recent systematic review has provided some indication of benefit, the analysis is limited by the quality of the available evidence from randomized controlled trials. To supplement the existing information, the authors conducted a systematic review of observational studies of antiviral treatment for influenza. This report summarises the findings of that review. Similar to the randomised trials, the confidence in the estimates of the effects for decision-making is low to very low primarily due to the risk of selection and publication bias in the observational studies. From these observational studies, the summary estimates suggest that oseltamivir may reduce mortality, hospitalisation and duration of symptoms compared with no treatment. Inhaled zanamivir may also reduce symptom duration and hospitalisations, but patients may experience more complications compared with no treatment. Earlier treatment with antivirals is generally associated with better outcomes than later treatment. Further high-quality evidence is needed to inform treatment guidelines because of the overall low to very low quality of evidence.
尽管抗病毒药物被用于治疗重症流感患者，但对于其疗效和安全性仍存在疑问。尽管最近的一项系统评价提供了一些有益的迹象，但由于随机对照试验提供的证据质量有限，该分析存在局限性。为了补充现有信息，作者对流感抗病毒治疗的观察性研究进行了系统评价。本报告总结了该评价的结果。与随机试验类似，由于观察性研究中存在选择和发表偏倚的风险，因此对于决策而言，对疗效评估的信心度低至极低。从这些观察性研究中，汇总估计表明，与不治疗相比，奥司他韦可能降低死亡率、住院率和症状持续时间。吸入扎那米韦也可能缩短症状持续时间和住院时间，但与不治疗相比，患者可能会经历更多的并发症。抗病毒药物的早期治疗通常与更好的结局相关，而晚期治疗则不然。由于证据总体质量低至极低，需要进一步的高质量证据来为治疗指南提供信息。
