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Comment & Response |

Neuraminidase Inhibitors and Influenza Infection—Reply

Janice K. Louie, MD, MPH1; Harry Lampiris, MD1,2
[+] Author Affiliations
1Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco
2San Francisco VA Health Care System, San Francisco, California
JAMA Intern Med. 2016;176(3):416-417. doi:10.1001/jamainternmed.2016.0050.
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In Reply We appreciate the interest generated by our Viewpoint.1

In their Cochrane review,2 Jefferson and Doshi have conducted a thorough and rigorous analysis of the available randomized clinical trial (RCT) data. However, the authors themselves acknowledge the limitations of their conclusions given the quality of the studies reviewed, stating: “Hospitalizations are an important but poorly defined outcome in the oseltamivir protocols, inconsistently reported in the clinical study reports and overlooked in the zanamivir protocols and reports. The oseltamivir trials did not detect any influenza-related deaths, reflecting the relatively benign nature of influenza in the study populations.”2 Cochrane reviews set rigorous standards for deciding which studies to include, preferentially including RCTs over observational studies, and typically result in conservative recommendations. However, the inability to show benefit under the most rigorous study conditions does not mean that benefit does not exist.3 Given this, it is reasonable to consider the available non-RCT data when evaluating the usefulness of neuraminidase inhibitor drugs (NAI) for influenza.


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March 1, 2016
Michael Osthoff, MD; Stefan Erb, MD
1Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
JAMA Intern Med. 2016;176(3):415. doi:10.1001/jamainternmed.2016.0013.
March 1, 2016
Peter Doshi, PhD; Tom Jefferson, MD, MRCGP, FFPHM
1Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
2Centre for Evidence-Based Medicine, Oxford University, Oxford, United Kingdom
JAMA Intern Med. 2016;176(3):415-416. doi:10.1001/jamainternmed.2016.0016.
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