title: Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-2010 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients.
abstract: BACKGROUND
  The impact of neuraminidase inhibitor (NAI) treatment on clinical outcomes of public health importance during the 2009-2010 pandemic has not been firmly established.
  
  
  METHODS
  We conducted a systematic review and meta-analysis, searching 11 databases (2009 through April 2012) for relevant studies. We used standard methods conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random effects models.
  
  
  RESULTS
  Regarding mortality we observed a nonsignificant reduction associated with NAI treatment (at any time) versus none (OR, 0.72 [95% CI, .51-1.01]). However we observed significant reductions for early treatment (≤48 hours after symptom onset) versus late (OR, 0.38 [95% CI, .27-.53]) and for early treatment versus none (OR, 0.35 [95% CI, .18-.71]). NAI treatment (at any time) versus none was associated with an elevated risk of severe outcome (OR, 1.76 [95% CI, 1.22-2.54]), but early versus late treatment reduced the likelihood (OR, 0.41 [95% CI, .30-.56]).
  
  
  CONCLUSIONS
  During the 2009-2010 influenza A(H1N1) pandemic, early initiation of NAI treatment reduced the likelihood of severe outcomes compared with late or no treatment.
  CRD42011001273.
authors.affiliation: Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, United Kingdom.
authors.forename: Stella G
authors.initials: SG
authors.lastname: Muthuri
authors.forename: Puja R
authors.initials: PR
authors.lastname: Myles
authors.forename: Sudhir
authors.initials: S
authors.lastname: Venkatesan
authors.forename: Jo
authors.initials: J
authors.lastname: Leonardi-Bee
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Nguyen-Van-Tam
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects*; D007251:Influenza, Human / Q000150:complications* / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D058873:Pandemics; D011634:Public Health; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D009439:Neuraminidase