Shim So-Jung, Chan Mei, Owens Louisa, Jaffe Adam, Prentice Bernadette, Homaira Nusrat
Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine University of New South Wales Sydney New South Wales Australia.
Respiratory Department Sydney Children's Hospital Randwick Sydney New South Wales Australia.
Health Sci Rep. 2021 Feb 10;4(1):e241. doi: 10.1002/hsr2.241. eCollection 2021 Mar.
Oseltamivir is recommended in the treatment of influenza illness in high-risk populations, including those with chronic heart and lung diseases.
We conducted a systematic review and meta-analysis to determine the rate of use and effectiveness of oseltamivir in these groups of patients.
The protocol for the systematic review was registered on PROSPERO (CRD42019125998). Medline, EMBASE, Cochrane CENTRAL, and CINAHL were searched for observational studies and randomized controlled trials published up to 16 February 2020. Quality appraisal of final studies was conducted using GRADE guidelines. Data were extracted using a predeveloped template. Main outcomes measured included the rate of use of oseltamivir for influenza-like-illness and its effectiveness in reducing disease severity in patients with cardiopulmonary diseases. Outcomes measured for effectiveness were influenza-related complications (respiratory infections and asthma exacerbations), hospitalization rates, and time to freedom from illness. Risk of bias was assessed using Cochrane's Risk of Bias 2.0 tool for randomized trials and Cochrane's Risk of Bias in nonrandomized Studies of Interventions tool for nonrandomized trials. Where data were available, pooled analyses were conducted. Dichotomous variables were evaluated using the Mantel-Hansel method. A random effect model was applied. Summary measures were reported as risk ratios where relevant.
Our systematic review identified nine studies. Oseltamivir use ranged from 25% to 100%. When oseltamivir group was compared to placebo, rates of respiratory tract infections reduced by 28% (RR = 0.72, 95% CI = 0.59-0.90), hospitalization reduced by 52% (RR = 0.48, 95% CI = 0.28-0.80) and median time to illness alleviation decreased by 10.4 to 120 hours. There was no significant reduction in asthma exacerbation rates.
Our systematic review suggests that the use of oseltamivir is beneficial in reducing disease severity, however, its use in high-risk population remains suboptimal.
在包括患有慢性心肺疾病患者在内的高危人群中，推荐使用奥司他韦治疗流感疾病。
我们进行了一项系统评价和荟萃分析，以确定奥司他韦在这些患者群体中的使用频率和有效性。
该系统评价方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42019125998）登记。检索了Medline、EMBASE、Cochrane中心对照试验注册库和护理学与健康领域数据库（CINAHL），纳入截至2020年2月16日发表的观察性研究和随机对照试验。使用GRADE指南对最终纳入的研究进行质量评估。使用预先制定的模板提取数据。主要测量结局包括奥司他韦用于治疗流感样疾病的频率及其在降低心肺疾病患者疾病严重程度方面的有效性。评估有效性的结局包括流感相关并发症（呼吸道感染和哮喘加重）、住院率以及痊愈时间。使用Cochrane偏倚风险2.0工具评估随机试验的偏倚风险，使用Cochrane非随机干预研究偏倚风险工具评估非随机试验的偏倚风险。在数据可用的情况下，进行汇总分析。使用Mantel-Hansel方法评估二分变量。应用随机效应模型。在相关情况下，汇总测量结果以风险比报告。
我们的系统评价纳入了9项研究。奥司他韦的使用率在25%至100%之间。当将奥司他韦组与安慰剂组进行比较时，呼吸道感染率降低了28%（风险比=0.72，95%置信区间=0.59-0.90），住院率降低了52%（风险比=0.48，95%置信区间=0.28-0.80），疾病缓解的中位时间缩短了10.4至120小时。哮喘加重率没有显著降低。
我们的系统评价表明，使用奥司他韦有助于降低疾病严重程度，然而，其在高危人群中的使用仍未达到最佳水平。
