University of Oulu

Tejada, S., Jansson, M., Solé-Lleonart, C., & Rello, J. (2021). Neuraminidase inhibitors are effective and safe in reducing influenza complications: meta-analysis of randomized controlled trials. European Journal of Internal Medicine, 86, 54–65.

Neuraminidase inhibitors are effective and safe in reducing influenza complications : meta-analysis of randomized controlled trials

Saved in:
Author: Tejada, Sofía1,2; Jansson, Miia3; Solé-Lleonart, Candela4;
Organizations: 1CIBER de Enfermedades Respiratorias (CIBERES), Instituto Salud Carlos III, Barcelona, Spain
2Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
3University of Oulu, Oulu University Hospital, Oulu, Finland
4Intensive Care Unit, Hospital Universitari de Vic, Barcelona, Spain
5Clinical Research, CHU Nimes, Université de Nîmes-Montpellier, France
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2022-01-05


Background: There is scarce evidence verifying the impact of neuraminidase inhibitors (NAIs) in reducing influenza complications. The aim was to evaluate the available evidence from randomized-controlled trials (RCT) regarding the efficacy and safety of NAIs in reducing influenza complications.

Methods: A systematic search of the literature was performed in the Cochrane Library, PubMed and Web of Science databases (2006–2019). Eligibility criteria were RCT that enrolled patients of any age or clinical severity with seasonal influenza (H₁N₁, H₃N₂, or B) or influenza-like syndrome and receiving NAIs comparing to placebo therapy.

Results: Eighteen RCTs (9004 patients) were included: nine focused on oral oseltamivir, six on inhaled zanamivir, and three on intravenous peramivir. Administration of NAIs therapy significantly decreased the time to clinical resolution (median difference: -17.7 hours; and total influenza-related complications (OR: 0.64, 95%CI: 0.51–0.82). In addition, NAIs significantly decreased acute otitis media complication (OR: 0.50, 95%CI: 0.31–0.82) and need for antibiotic treatment (OR: 0.64, 95%CI: 0.46–0.90); and showed a trend towards a reduced occurrence of pneumonia (OR: 0.44, 95%CI: 0.10–2.00), bronchitis (OR: 0.80, 95%CI: 0.43–1.48), sinusitis (OR: 0.73, 95%CI: 0.40–1.32), asthma exacerbations (OR: 0.57, 95%CI: 0.28–1.16), and hospitalizations (OR: 0.57, 95%CI: 0.24–1.38). The overall proportion of AEs tend to increase with NAIs treatment (OR: 1.16, 95%CI: 0.92–1.47). Use of NAIs was associated with a significant increase of nausea and vomiting (OR: 1.61, 95%CI: 1.04–2.50) and a decrease on diarrhea (OR: 0.81, 95%CI: 0.65–1.00).

Conclusions: NAIs are effective in reducing time to clinical resolution, total influenza-related complications, otitis media, and need of antibiotic administration. Reductions on mortality, pneumonia, asthma exacerbations or hospitalization rates only did demonstrate a trend benefit in favor of NAIs. The only significant AE is the increased occurrence of nausea and vomiting.

see all

Series: European journal of internal medicine
ISSN: 0953-6205
ISSN-E: 1879-0828
ISSN-L: 0953-6205
Volume: 86
Pages: 54 - 65
DOI: 10.1016/j.ejim.2020.12.010
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3142 Public health care science, environmental and occupational health
Copyright information: © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license