Multisystem failure: the story of anti-influenza drugs

  title={Multisystem failure: the story of anti-influenza drugs},
  author={Tom Jefferson and Peter Doshi},
  journal={BMJ : British Medical Journal},
Last year the Cochrane team, with the help of the BMJ’s open data campaign, finally got access to full clinical study reports on neuraminidase inhibitors. Tom Jefferson and Peter Doshi explain what the new systematic review found and how a series of failures meant that decisions about these drugs were made without the full evidence 

The neuraminidase inhibitors evidence of harms – in context

The evidence fails to support the mechanism of action mediated through antiviral action put forward by the manufacturers, and it is found that symptom relief occurs in a whole population with influenzalike symptoms many of whom will not have influenza.

Authors’ reply to Dunning

Dunning questions the relevance of our systematic review, suggesting that any research data—regardless of its quality—that tests the effect of neuraminidase inhibitors on non-pandemic influenza

Potential adverse effects of negative publicity surrounding antivirals for influenza

  • J. Dunning
  • Medicine
    BMJ : British Medical Journal
  • 2014
The latest Cochrane review of neuraminidase inhibitors for influenza was impressive but did not investigate antiviral effectiveness in severe influenza, illness caused by pandemic H1N1.

Effect of early oseltamivir treatment on mortality in critically ill patients with different types of influenza: a multi-season cohort study.

Severely ill patients with suspected influenza should be promptly treated with oseltamivir, particularly when A/H3N2 is circulating, but the efficacy should not be assumed to be equal against all types of influenza.

Financial Conflicts of Interest and Conclusions About Neuraminidase Inhibitors for Influenza

Whether there is an association between financial conflicts of interest and the favorable presentation of evidence in systematic reviews on the use of neuraminidase inhibitors for the prophylaxis and treatment of influenza is determined.

The Tamiflu fiasco and lessons learnt

This article takes a comprehensive relook on the Tamiflu saga, and suggests some ways and means to avoid a similar situation in the future.

Ebola in west Africa.

Influenza Antiviral Expenditures and Outpatient Prescriptions in the United States, 2003–2012

The objectives of this study were to describe influenza antiviral expenditures overall and by health care setting over a 10‐year period and to assess the correlation between outpatient flu antiviral prescription use and influenza‐like illness (ILI) outpatient visits.

Neuraminidase Inhibitors in Influenza Treatment and Prevention–Is It Time to Call It a Day?

A mathematical model of influenza infection was used and it was indicated that contributions of oseltamivir to epidemic control could be high, but were observed only in fragile settings and the efficacy was limited by design.



Neuraminidase inhibitors—the story behind the Cochrane review

  • P. Doshi
  • Medicine
    BMJ : British Medical Journal
  • 2009
Although billions have been spent on oseltamivir in the face of pandemic influenza, the team updating the Cochrane review of neuraminidase inhibitors in healthy adults found that the public evidence

Complications: tracking down the data on oseltamivir

  • D. Cohen
  • Medicine
    BMJ : British Medical Journal
  • 2009
A Cochrane group’s attempt to reproduce an analysis underpinning the use of oseltamivir in pandemic influenza hit a brick wall. Deborah Cohen retraces its steps

What does oseltamivir do, and how will we know?

Two different groups are now working on meta-analyses of the unpublished patient level data on the effects of oseltamivir in flu. Will they come to the same conclusions?

Rethinking credible evidence synthesis

After publication of a Cochrane review into the effectiveness of oseltamivir in 2009, the reviewers got access to thousands of pages of previously unavailable data, which shook their faith in published reports and changed their approach to systematic reviews.

Point-by-point response from Roche to BMJ questions

James Smith responds on behalf of Roche to some of the issues raised with regard to the Cochrane Review on oseltamivir published in the BMJ (doi:10.1136/bmj.b5106)

Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children.

The effects of oseltamivir on time to first alleviation of symptoms and hospitalisations using the intention-to-treat (ITT) population and tested five hypotheses generated post-protocol publication are reviewed.

Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis

The remaining evidence suggests oseltamivir did not reduce influenza related lower respiratory tract complications and neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults.

The Imperative to Share Clinical Study Reports: Recommendations from the Tamiflu Experience

Peter Doshi and colleagues describe their experience trying and failing to access clinical study reports from the manufacturer of Tamiflu and challenge industry to defend their current position of

Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations.

Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults.