Treatment of influenza with neuraminidase inhibitors: virological implications.
Evaluation of the emergence of influenza virus resistance to neuraminidase inhibitors (NAIs) is now demanded following experience with amantadinamines. Preliminary data have indicated that NAI-resistant virus is unlikely to emerge readily in the clinic and this is consistent with the difficulty experienced in selecting resistant virus in vitro. Resistance mutations can occur in both neuraminidase and haemagglutinin genes. The neuraminidase mutations are viral subtype specific and, therefore, clinically relevant subtypes must be employed for in vitro studies if pre-clinical data are to have predictive value. Haemagglutinin mutations generated in vitro are probably both subtype and cell culture system specific and, therefore, may not be predictive of clinical findings. Analysis of influenza-positive samples from NAI-treated patients in the clinical setting must include samples from late treatment time-points (day 4 and later) in order for resistant virus to be detected as in vitro studies and current clinical experience have indicated that resistant virus is slow to emerge and is transient.
Roberts
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Roche Products Ltd, Broadwater Road, Welwyn Garden City, Hertfordshire AL7 3AY, UK. noel.roberts@roche.com
D000081:Acetamides / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024921:Drug Resistance, Multiple, Viral; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006146:Guanidines; D006801:Humans; D009980:Influenza A virus / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D009981:Influenza B virus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000188:drug therapy* / Q000821:virology*; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D053139:Oseltamivir; D011714:Pyrans; D012794:Sialic Acids / Q000494:pharmacology / Q000627:therapeutic use; D053243:Zanamivir
D000081:Acetamides; D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D006146:Guanidines; D011714:Pyrans; D012794:Sialic Acids; D053139:Oseltamivir; D009439:Neuraminidase; D053243:Zanamivir