A Meta-Analysis Comparing the Efficacy and Safety of Peramivir with Other Neuraminidase Inhibitors for Influenza Treatment
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Search Strategy and Selection
2.2. Data Extraction and Outcome Assessment
2.3. Data Analysis and Study Quality Assessment
3. Results
3.1. Study Search Outcomes and Included Patients
3.2. Meta-Analysis of Clinical Efficacy
3.3. Risk of Adverse Event
3.4. Heterogeneity and Publication Bias
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Abbreviations
NAI | neuraminidase inhibitors |
RCTs | randomized controlled trials |
OSs | observational studies |
GRADE | Grading of Recommendations, Assessments, Development, and Evaluations |
RoB 2.0 | cochrane risk-of-bias assessment tool 2.0 |
ROBINS | risk of bias in non-randomized studies of interventionsg |
MD | difference in meanss |
RR | risk ratio |
CI | confidence interval |
AE | adverse events |
SAE | serious adverse events |
Appendix A. List of Terms Used in the Search
References
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Randomized (RoB 2.0) | Domains 1 | Domains 2 | Domains 3 | Domains 4 | Domains 5 | Overall Bias |
---|---|---|---|---|---|---|
Kohno, S 2010 | Low | Low | Low | Low | Low | Low |
Ison, MG 2013 | Low | Low | Low | Low | Low | Low |
Nakamura, S 2017 | Low | Low | Some concerns * | Low | Some concerns + | Some concerns |
Yoshino, Y 2017 | Some concerns+ | High * | Low | High* | Some concerns # | High |
Hirotsu, N 2018 | Low | High # | Some concerns * | Low | Some concerns * | High |
Non-Randomized (ROBINS-I) | Domain 1 | Domain 2 | Domain 3 | Domain 4 | Domain 5 | Domain 6 | Domain 7 | Overall |
---|---|---|---|---|---|---|---|---|
Sakata, H 2011 | Low | Low | Low | Low | Low | Low | Low | Low |
Hikita, T 2012 | Low | Low | Low | Low | Low | Low | Low | Low |
Shobugawa, Y 2012 | Low | Low | Low | Low | No information | Low | Low | Low |
Takemoto, Y 2013 | Low | Low | Low | Low | Low | Low | Low | Low |
Sugaya, N 2015 | Low | Low | Low | Moderate * | No information | Low | Low | Moderate * |
Yoshino, Y 2015 | Low | Low | Low | No information | Low | Low | Low | Low |
Tochino, Y 2017 | Low | Low | Low | No information | Serious ** | Low | Low | Serious ** |
GRADE Assessment | |||||||
---|---|---|---|---|---|---|---|
Certainty Assessment | Certainty | ||||||
No of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | |
Time to Alleviation of Symptoms | |||||||
5 | randomized trials | serious a | not serious | not serious | not serious | none | ⨁⨁⨁◯ MODERATE |
7 | observational studies | serious b | serious b | not serious | very serious c | strong associationall plausible residual confounding would suggest spurious effect, while no effect was observed | ⨁⨁◯◯ LOW |
Risk of Adverse Events | |||||||
3 | randomized trials | serious a | not serious | not serious | not serious | none | ⨁⨁⨁◯ MODERATE |
1 | observational studies | not serious | not serious | not serious | not serious | none | ⨁⨁⨁⨁ HIGH |
Risk of Serious Adverse Event | |||||||
3 | randomized trials | serious a | not serious | not serious | not serious | none | ⨁⨁⨁◯ MODERATE |
Author, Year | Influenza Virus Subtype | Patient Enrollment Criteria | Sample Number (Men/Women) | Age (Mean ± SD) | Age Group | Blind | Treatment Protocol | Outcome Measurement |
---|---|---|---|---|---|---|---|---|
Randomized controlled trials | ||||||||
Kohno S et al., 2011 | A(H1) A(H3) B | Rapid test positive, body temperature ≧38.0 °C, two moderate to severe symptoms among seven symptoms: headache, muscle or joint pain, feverishness or chills, fatigue, cough, sore throat, and nasal stuffiness. | Peramivir: 726 (378/348) Oseltamivir: 365 (184/181) | Peramivir: 35.4 ± 11.6 Oseltamivir: 34.6 ± 11.7 | >18 | Yes, but no details of blind description | Intravenous with peramivir 300 or 600 mg once daily for 5 days or oral oseltamivir 75 mg twice daily for 5 days. | Time to alleviation of symptoms, change from the influenza virus titer, adverse events. |
Ison MG et al., 2013 | A(H1N1) A(H3N2) B | Rapid test positive, influenza-like illness within the previous 72 h with documented fever or feverishness, ≥1 respiratory symptom (cough, sore throat or nasal congestion), ≥1 constitutional symptom (headache, myalgia, feverishness or malaise/fatigue). | Peramivir: 81 (38/43) Oseltamivir: 41 (19/22) | Peramivir: 58.0 ± 23.0 Oseltamivir: 62.2 ± 21.1 | >18 | Participant, care provider, investigator, outcomes assessor. | Intravenous with peramivir 200 or 400 mg once daily for 5 days or oral oseltamivir 75 mg twice daily for 5 days. | Time to clinical stability, time to alleviation of symptoms, time to hospital discharge, time to resumption of usual activities, change from the influenza virus titer, adverse events. |
Nakamura S et al., 2017 | A(H3N2), A(H1N1) pdm09 B | Rapid test positive, body temperature ≥ 38.0 °C, treatment within 48 hours influenza illness as indicated by at least 1 symptom: headache, muscle or joint pain, feverishness or chills, and fatigue as general symptoms, and cough, sore throat, and nasal stuffiness as respiratory symptoms. | Peramivir: 46 (21/25) Oseltamivir: 46 (22/24) | Peramivir: 72.2 ± 14.1 Oseltamivir: 70.1 ± 11.1 | >18 | NO | Intravenous with peramivir 600 mg once daily (a second infusion at >2 days later, if necessary, was permitted) or oral oseltamivir 75 mg twice daily for 5 days. | Time to alleviation fever, time to alleviation of symptoms, change from the influenza virus titer, adverse events. |
Yoshino Y et al., 2017 | A B | Rapid test positive, axillary temperature ≥37.0 °C, influenza-like illness, including fever, muscle pain, chills, sweating, headache, dry cough, fatigue, nasal congestion, and respiratory failure. | Peramivir: 13 (6/7) Oseltamivir: 9 (3/6) Laninamivir: 12 (3/9) | Peramivir: 43.6 ± 15.3 Oseltamivir: 40.4 ± 9.84 Laninamivir: 36.2 ± 10.0 | >18 | NO | Intravenous with peramivir 300 mg once daily or oseltamivir 75 mg twice daily for 5 days or inhaled laninamivir 40 mg once daily. | Time to alleviation fever, alleviation of other symptoms. |
Hirotsu N et al., 2018 | A(H1N1) A(H3N2) A(H1N1) pdm09 B | Rapid test positive, axillary temperature ≥37.5 °C, influenza-like illness (cough, sore throat, headache, nasal discharge, muscle or joint pain, and fatigue). | Peramivir: 28 (15/13) Oseltamivir: 30 (22/8) Zanamivir: 26 (9/17) Laninamivir: 30 (13/17) | All groups between 4-12 | ≤18 | NO | Intravenous with peramivir 10 mg/kg once daily or oral oseltamivir 2 mg/kg twice daily, ≧37.5 kg or oral oseltamivir 75 mg twice daily for 5 days or inhaled zanamivir 10 mg twice daily for 5 days or inhaled laninamivir 40 mg (≥10 years) or 20 mg (<10 years) once daily. | Time to virus clearance, time to alleviation of fever, time to alleviation of symptoms, adverse events. |
Author, Year | Influenza Virus Subtype | Patient Enrollment Criteria | Sample Number (Men/Women) | Age (Mean ± SD) | Age Group | Treatment Protocol | Outcome Measurement |
---|---|---|---|---|---|---|---|
Observational studies | |||||||
Sakata H, 2011 | A B | Rapid test positive, influenza-like illness within the previous 48 h. | Peramivir: 30 (N/A) Oseltamivir: 30 (N/A) | Peramivir: 1.8 ± 4.9 Oseltamivir: 2.0 ± 3.9 | ≤18 | Intravenous with peramivir 10 mg/kg once daily or oral oseltamivir 4 mg/kg daily. | Time to alleviation fever, adverse events. |
Hikita T et al., 2012 | A B | Rapid test positive, fever lasting for less than 48 h. | Peramivir: 63 (N/A) Oseltamivir: 124 (N/A) Zanamivir: 38 (N/A) Laninamivir: 14 (N/A) | Peramivir: 7.8 ± 42.4 Oseltamivir: 5.2 ± 34.2 Zanamivir: 10.5 ± 11.4 Laninamivir: 10.6 ± 5.8 | ≤18 | Intravenous with peramivir 10 mg/kg once daily or oral oseltamivir 2 mg/kg twice daily for 5 days or inhaled zanamivir 10 mg twice daily for 5 days or inhaled laninamivir 40 mg (≥10 years) or 20 mg (<10 years) once daily. | Time to alleviation fever, adverse events. |
Shobugawa Y et al., 2012 | A(H3N2), A(H1N1) pdm09 | Rapid test positive, fever ≥ 37.5 °C with respiratory symptoms, headache, arthralgia, or myalgia | Peramivir: 4 (3/1) Oseltamivir: 119 (60/59) Zanamivir: 124 (78/46) Laninamivir: 9 (3/6) | Peramivir: 8.8 ± 3.9 Oseltamivir: 4.9 ± 2.3 Zanamivir: 9.4 ± 2.5 Laninamivir: 10.2 ± 2.3 | Mix | Intravenous with peramivir 300 or 600 mg with adult or 10 mg/kg for children once daily or oral oseltamivir 75 mg twice daily with adult or 2 mg/kg twice daily with children for 5 days or inhaled zanamivir 10 mg twice daily for 5 days or inhaled laninamivir 40 mg (≥10 years) or 20 mg (<10 years) once daily. | Time to alleviation fever. |
Takemoto Y et al., 2013 | A B | Rapid test positive. | Peramivir: 53 (32/21) Oseltamivir: 51 (26/25) Zanamivir: 39 (28/11) Laninamivir: 44 (25/19) | Peramivir: 34.8 ± 23.2 Oseltamivir: 19.0 ± 27.0 Zanamivir: 17.8 ± 18.6 Laninamivir: 26.3 ± 23.2 | Mix | Intravenous with peramivir 300 mg with adult or 10 mg/kg for children once daily or oral oseltamivir 75 mg twice daily with adult or 2 mg/kg twice daily with children for 5 days or inhaled zanamivir 10 mg twice daily for 5 days or inhaled laninamivir 40 mg (adult) or 20 mg (children) once daily. | Time to alleviation fever. |
Sugaya N et al., 2015 | A(H3N2), A(H1N1) pdm09 | Rapid test positive, fever >38 °C, upper respiratory symptoms such as cough or rhinorrhoea. | Peramivir: 17 (N/A) Oseltamivir: 163 (N/A) Laninamivir: 33 (N/A) | Peramivir: 7.6 ± 3.8 Oseltamivir: 6.3 ± 1.8 Laninamivir: 8.3 ± 2.0 | ≤18 | Intravenous with peramivir 10 mg/kg once daily or oral oseltamivir weight-based dose twice daily for 5 days or inhaled laninamivir 20 mg once daily. | Viral shedding patterns, time to alleviation fever |
Yoshino Y et al., 2015 | Not mentioned | Rapid test positive, oral temperature ≥37.2 °C, influenza-like illness. | Peramivir: 23 (14/9) Oseltamivir: 9 (4/5) | Peramivir: 77.6 ± 14.4 Oseltamivir: 70.3 ± 13.8 | >18 | Intravenous with peramivir 300 mg once daily or oral oseltamivir 75 mg twice daily for 5 days. | Time to defervescence, survival rate, side effects |
Tochino Y et al., 2017 | A B | Rapid test positive, fever ≥ 37 °C influenza-like illness. | Peramivir: 10 (4/6) Oseltamivir: 108 (55/53) Zanamivir: 28 (14/14) Laninamivir: 95 (43/52) | Peramivir: 44.0 ± 53.2 Oseltamivir: 25.3 ± 343.3 Zanamivir: 15.8 ± 70.9 Laninamivir: 33.0 ± 273.5 | Mix | Not mentioned | Time to alleviation fever, time to alleviation of symptoms, adverse events. |
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Chen, J.-Y.; Wei, S.-K.; Lai, C.-C.; Weng, T.-S.; Wang, H.-H. A Meta-Analysis Comparing the Efficacy and Safety of Peramivir with Other Neuraminidase Inhibitors for Influenza Treatment. Medicina 2020, 56, 63. https://doi.org/10.3390/medicina56020063
Chen J-Y, Wei S-K, Lai C-C, Weng T-S, Wang H-H. A Meta-Analysis Comparing the Efficacy and Safety of Peramivir with Other Neuraminidase Inhibitors for Influenza Treatment. Medicina. 2020; 56(2):63. https://doi.org/10.3390/medicina56020063
Chicago/Turabian StyleChen, Jui-Yi, Shih-Kai Wei, Chih-Cheng Lai, Teng-Song Weng, and Hsin-Hua Wang. 2020. "A Meta-Analysis Comparing the Efficacy and Safety of Peramivir with Other Neuraminidase Inhibitors for Influenza Treatment" Medicina 56, no. 2: 63. https://doi.org/10.3390/medicina56020063