Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Japan.
Intern Med. 2021;60(21):3401-3408. doi: 10.2169/internalmedicine.6416-20. Epub 2021 Nov 1.
Objective Maoto is a traditional Japanese Kampo formula used to treat influenza. However, clinical evidence for maoto has been limited to small-scale studies of its effect in alleviating symptoms. The present study evaluated whether or not the addition of maoto to a neuraminidase inhibitor was associated with a reduction in hospitalization following influenza. Methods Using the JMDC Claims Database, we identified outpatients <60 years old who were diagnosed with influenza by an antigen test from September 2013 to August 2018. One-to-five propensity score matching was conducted between patients who received maoto in addition to a neuraminidase inhibitor and those who received a neuraminidase inhibitor alone. Hospitalization within seven days of the influenza diagnosis was compared in the matched groups using the Mantel-Haenszel test. Results We identified 1.79 million cases of influenza from the database in the 5-year study period. Maoto was prescribed for 3.9% of the 1.67 million cases receiving a neuraminidase inhibitor. In the 64,613 propensity score-matched groups of patients, the 7-day hospitalization rate was 0.116% (n=75) for patients with maoto and 0.122% (n=394) for patients without maoto. The difference between these treatment groups was nonsignificant (common odds ratio, 0.95; 95% confidence interval, 0.74 to 1.22; p=0.695). Conclusion The addition of maoto to a neuraminidase inhibitor was not associated with a decrease in hospitalization among nonelderly patients with influenza. Further research is necessary to clarify the indication and efficacy of maoto.
目的 万痛定是一种传统的日本汉方药，用于治疗流感。然而，万痛定的临床证据仅限于其缓解症状的小规模研究。本研究评估了在流感患者中，加用万痛定是否与住院率降低相关。
方法 使用 JMDC 理赔数据库，我们确定了 2013 年 9 月至 2018 年 8 月期间，通过抗原检测诊断为流感且年龄<60 岁的门诊患者。对接受神经氨酸酶抑制剂加用万痛定和单独使用神经氨酸酶抑制剂的患者进行 1:5 倾向评分匹配。使用 Mantel-Haenszel 检验比较匹配组中流感诊断后 7 天内的住院情况。
结果 在 5 年的研究期间，我们从数据库中确定了 179 万例流感病例。在接受神经氨酸酶抑制剂治疗的 1670 万例患者中，有 3.9%的患者处方了万痛定。在 64613 对经倾向评分匹配的患者组中，万痛定组的 7 天住院率为 0.116%（n=75），而无万痛定组的住院率为 0.122%（n=394）。两组之间的差异无统计学意义（共同优势比，0.95；95%置信区间，0.74 至 1.22；p=0.695）。
结论 在流感非老年患者中，加用万痛定与住院率降低无关。需要进一步研究来阐明万痛定的适应证和疗效。
