Multisystem failure: the story of anti-influenza drugs

@article{Jefferson2014MultisystemFT,
  title={Multisystem failure: the story of anti-influenza drugs},
  author={Tom Jefferson and Peter Doshi},
  journal={BMJ : British Medical Journal},
  year={2014},
  volume={348}
}
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 

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References

SHOWING 1-10 OF 22 REFERENCES
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 evidenceExpand
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Two different groups are now working on meta-analyses of the unpublished patient level data on the effects of oseltamivir in flu.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
TLDR
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. Expand
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.
TLDR
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. Expand
Neuraminidase inhibitors for preventing and treating influenza in healthy adults: systematic review and meta-analysis
TLDR
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. Expand
Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial
TLDR
Oseltamivir was effective and well tolerated in the treatment of natural influenza infection in adults and was associated with higher symptom scores, less viral shedding, and improved health, activity, and sleep quality. Expand
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 ofExpand
Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations.
TLDR
Oseltamivir treatment of influenza illness reduces LRTCs, antibiotic use, and hospitalization in both healthy and "at-risk" adults. Expand
...
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