Yonsei Med J.  2017 Jul;58(4):778-785. 10.3349/ymj.2017.58.4.778.

Comparison of Efficacy of Intravenous Peramivir and Oral Oseltamivir for the Treatment of Influenza: Systematic Review and Meta-Analysis

• Lee J
• Park JH
• Jwa H
• Kim YH

• KMID: 2419084
• DOI: http://doi.org/10.3349/ymj.2017.58.4.778

Abstract

PURPOSE
Peramivir is the first intravenously administered neuramidase inhibitor for immediate delivery of an effective single-dose treatment in patients with influenza. However, limited data are available on intravenous (IV) peramivir treatment compared to oral oseltamivir for these patients.
MATERIALS AND METHODS
With a systematic review and meta-analysis, we compared the efficacy of IV peramivir with oral oseltamivir for treatment of patients with seasonal influenza. MEDLINE, EMBASE, and Cochrane Central Register were searched for relevant clinical trials.
RESULTS
A total of seven trials [two randomized controlled trials (RCTs) and five non-randomized observational trials] involving 1676 patients were finally analyzed. The total number of peramivir- and oseltamivir-treated patients was 956 and 720, respectively. Overall, the time to alleviation of fever was lower in the peramivir-treated group compared with the oseltamivir-treated group [mean difference (MD), −7.17 hours; 95% confidence interval (CI) −11.00 to −3.34]. Especially, pooled analysis of observational studies (n=4) and studies of outpatients (n=4) demonstrated the superiority of the peramivir-treated group (MD, -7.83 hours; 95% CI −11.81 to −3.84 and MD, −7.71 hours; 95% CI −11.61 to −3.80, respectively). Mortality, length of hospital stay, change in virus titer 48 hours after admission, and the incidence of adverse events in these patients were not significantly different between the two groups.
CONCLUSION
IV peramivir therapy might reduce the time to alleviation of fever in comparison with oral oseltamivir therapy in patients with influenza; however, we could not draw clear conclusions from a meta-analysis because of the few RCTs available and methodological limitations.

Keyword

Influenza; human; peramivir; oseltamivir; fever; signs and symptoms; respiratory

MeSH Terms

Administration, Intravenous
Administration, Oral
Antiviral Agents/administration & dosage/adverse effects/therapeutic use
Cyclopentanes/*administration & dosage/adverse effects/*therapeutic use
Guanidines/*administration & dosage/adverse effects/*therapeutic use
Humans
Influenza, Human/*drug therapy/virology
Odds Ratio
Oseltamivir/*administration & dosage/adverse effects/*therapeutic use
Publication Bias
Randomized Controlled Trials as Topic
Risk Factors
Treatment Outcome
Antiviral Agents
Cyclopentanes
Guanidines
Oseltamivir

Figure

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  Fig. 1 Flow chart of study selection.

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  Fig. 2 Risk of bias summary (A) and risk of bias graph (B) for randomized controlled studies included in this meta-analysis.

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  Fig. 3 Pooled adjusted risk ratio results for time to alleviation of fever among patients with influenza treated with intravenous peramivir versus oral oseltamivir in randomized controlled trials (A) and observational studies (B). SD, standard difference; IV, inverse variance; CI, confidence interval; df, degrees of freedom.

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  Fig. 4 Pooled adjusted risk ratio results for time to alleviation of fever with intravenous peramivir versus oral oseltamivir in inpatients (A) and outpatients (B) with influenza. SD, standard difference; IV, inverse variance; CI, confidence interval; df, degrees of freedom.

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  Fig. 5 Pooled adjusted odds ratio results for secondary among patients with influenza treated with intravenous peramivir versus oral oseltamivir. Mortality (A), length of hospital stay in days (B), and changes in viral titers from baseline (C) to 48 hours. M-H, Mantel-Haenszel; CI, confidence interval; df, degrees of freedom; SD, standard difference; IV, inverse variance.

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  Fig. 6 Pooled analysis of adverse events among patients with influenza treated with intravenous peramivir versus oral oseltamivir. All adverse events (A) and serious adverse events (B). M-H, Mantel-Haenszel; CI, confidence interval; df, degrees of freedom.

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