Flu Antivirals - how good are they?


Flu antivirals: the good news (they work), the bad news (not very well), the good news in the bad news (we're not likely to lose much)

Yesterday (today as I am writing this) the British Medical Journal published another Cochrane meta-analysis on the efficacy of neurimminidase inhibitor antivirals (the only two in use now, being oseltamivir [Tamiflu] and zanimivir [Relenza]). Their conclusions have made the news, so I guess I should cast my baleful eye on their handiwork. I think there is less here than meets the eye, but first let's look at what meets the eye.

This is a meta-analysis, that is, an analysis of other analyses, the other analyses in this case being drug trials of Tamiflu or Relanza in children. So it's an observational study of experimental studies, if you follow me. "Experimental" in this context means studies on children where the investigators control the treatment assignment (an antiviral or a placebo or no treatment). In essence, it is a review article of other studies where the authors employ various qualitative and quantitative techniques to combine results to come up with a summary of the studies, taken together. It's more complicated than that, but that's the general idea. It's potentially better than the kind of reviews of the literature commonly done because it is very explicit about what kinds of analyses will be included and the methods of weighting the results are also explicit and often quite sophisticated. I say potentially better because it takes a very narrow view of the subject, only allowing data from scientific studies of a particular kind. The Cochrane consortium last looked at this question in 2005 and this article looks at what has been learned in the interim, clearly with an eye on the swine flu pandemic now underway. All of the analyses they looked at were for seasonal flu, not pandemic flu. How generalizable this is to pandemic flu is unclear, but it is reasonable to think it has relevance.

For the rest of their commentary, follow this link:


The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

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