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Sako A, Gu Y, Masui Y, Yoshimura K, Yanai H, Ohmagari N. Prescription of anti-influenza drugs in Japan, 2014-2020: A retrospective study using open data from the national claims database. PLoS One 2023; 18:e0291673. [PMID: 37792686 PMCID: PMC10550188 DOI: 10.1371/journal.pone.0291673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Both physicians and patients are proactive towards managing seasonal influenza in Japan and six drugs are approved. Although many countries have national influenza surveillance systems, data on nationwide prescription practices of anti-influenza drugs are lacking. Therefore, we aimed to clarify the status of anti-influenza drug use in Japan by analyzing real-world data. METHODS This retrospective study analyzed open data from the National Database of Health Insurance Claims and Specific Health Checkups, which covers most claims data from national health insurance. We estimated the annual number of patients prescribed anti-influenza drugs, which drugs they were prescribed, the patients' age and sex distribution, drug costs, and regional disparities for the period 2014-2020. RESULTS For 2014-2019, an estimated 6.7-13.4 million patients per year were prescribed anti-influenza drugs, with an annual cost of 22.3-48.0 billion JPY (Japanese Yen). In addition, 21.1-32.0 million rapid antigen tests were performed at a cost of 30.1-47.1 billion JPY. In 2017, laninamivir was the most frequently prescribed anti-influenza drug (48%), followed by oseltamivir (36%), while in 2018, the newly introduced baloxavir accounted for 40.8% of prescriptions. After the emergence of COVID-19, the estimated number of patients prescribed anti-influenza drugs in 2020 dropped to just 14,000. In 2018, 37.6% of prescriptions were for patients aged < 20 years compared with 12.2% for those aged ≥ 65 years. Prescriptions for inpatients accounted for 1.1%, and the proportion of prescriptions for inpatients increased with age, with men were more likely than women to be prescribed anti-influenza drugs while hospitalized. CONCLUSIONS Based on our clarification of how influenza is clinically managed in Japan, future work should evaluate the clinical and economic aspects of proactively prescribing anti-influenza drugs.
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Affiliation(s)
- Akahito Sako
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Yoshiaki Gu
- Department of Infectious Diseases, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Yoshinori Masui
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Kensuke Yoshimura
- Center for Next Generation of Community Health, Chiba University Hospital, Chuo-ku, Chiba, Japan
| | - Hidekatsu Yanai
- Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Maleki F, Welch V, Lopez SMC, Cane A, Langer J, Enstone A, Markus K, Wright O, Hewitt N, Whittle I. Understanding the Global Burden of Influenza in Adults Aged 18-64 years: A Systematic Literature Review from 2012 to 2022. Adv Ther 2023; 40:4166-4188. [PMID: 37470942 PMCID: PMC10499696 DOI: 10.1007/s12325-023-02610-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Adults aged 18-64 years comprise most of the working population, meaning that influenza infection can be disruptive, causing prolonged absence from the workplace, and reduced productivity and the ability to care for dependents. Influenza vaccine uptake is relatively low, even among the older adults in this population (i.e., aged 50-64 years), reflecting a lack of perceived need for vaccination. This systematic literature review (SLR) aimed to characterize the global burden of influenza in the 18-64 years population. METHODS An electronic database search was conducted and supplemented with conference and gray literature searches. Eligible studies described at least one of clinical, humanistic, or economic outcomes in adults aged 18-64 years and conducted across several global regions. Included studies were published in English, between January 1, 2012, and September 20, 2022. RESULTS A total of 40 publications were included, with clinical, humanistic, and economic outcomes reported in 39, 5, and 15, respectively. Risk of influenza-associated clinical outcomes were reported to increase with age among the 18-64 years population, including hospitalizations (Yamana et al. in Intern Med 60:3401-3408, 2021; Derqui et al. in Influenza Other Respir Viruses 16:862-872, 2022; Fuller et al. in Influenza Other Respir Viruses 16:265-275, 2022; Ortiz et al. in Crit Care Med 42:2325-2332, 2014; Yandrapalli et al. in Ann Transl Med 6:318, 2018; Zimmerman et al. in Influenza Other Respir Viruses 16:1133-1140, 2022). ICU admissions, mortality, ER/outpatient visits, and use of mechanical ventilation were recorded. Adults aged 18-64 years with underlying comorbidities were at higher risk of influenza-related hospitalizations, ICU admission, and mortality than otherwise healthy individuals. Length of hospital stay increased with age, although a lack of stratification across other economic outcomes prevented identification of further trends across age groups. CONCLUSIONS High levels of hospitalization and outpatient visits demonstrated a clinical influenza-associated burden on patients and healthcare systems, which is exacerbated by comorbidities. Considering the size and breadth of the general population aged 18-64 years, the limited humanistic and economic findings of this SLR likely reflect an underreported burden. Greater investigation into indirect costs and prolonged absenteeism associated with influenza infection is required to fully understand the economic burden in this population.
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Affiliation(s)
| | - Verna Welch
- Pfizer Vaccines Medical and Scientific Affairs, Collegeville, PA, USA
| | | | - Alejandro Cane
- Pfizer Vaccines Medical and Scientific Affairs, Collegeville, PA, USA
| | - Jakob Langer
- Pfizer Global Access and Value, Lisbon, Portugal
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Okada A, Hashimoto Y, Goto T, Yamaguchi S, Ono S, Ikeda Kurakawa K, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. A Machine Learning-Based Predictive Model to Identify Patients Who Failed to Attend a Follow-up Visit for Diabetes Care After Recommendations From a National Screening Program. Diabetes Care 2022; 45:1346-1354. [PMID: 35435949 DOI: 10.2337/dc21-1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Reportedly, two-thirds of the patients who were positive for diabetes during screening failed to attend a follow-up visit for diabetes care in Japan. We aimed to develop a machine-learning model for predicting people's failure to attend a follow-up visit. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study of adults with newly screened diabetes at a national screening program using a large Japanese insurance claims database (JMDC, Tokyo, Japan). We defined failure to attend a follow-up visit for diabetes care as no physician consultation during the 6 months after the screening. The candidate predictors were patient demographics, comorbidities, and medication history. In the training set (randomly selected 80% of the sample), we developed two models (previously reported logistic regression model and Lasso regression model). In the test set (remaining 20%), prediction performance was examined. RESULTS We identified 10,645 patients, including 5,450 patients who failed to attend follow-up visits for diabetes care. The Lasso regression model using four predictors had a better discrimination ability than the previously reported logistic regression model using 13 predictors (C-statistic: 0.71 [95% CI 0.69-0.73] vs. 0.67 [0.65-0.69]; P < 0.001). The four selected predictors in the Lasso regression model were lower frequency of physician visits in the previous year, lower HbA1c levels, and negative history of antidyslipidemic or antihypertensive treatment. CONCLUSIONS The developed machine-learning model using four predictors had a good predictive ability to identify patients who failed to attend a follow-up visit for diabetes care after a screening program.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan.,TXP Medical Co. Ltd, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Toranomon Hospital, Tokyo, Japan
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Hara A, Hara K, Komeda T, Ogura E, Miyazawa S, Kobayashi C, Fujiwara M, Yoshida M, Urushihara H. Comparison of the incidence of bleeding between baloxavir marboxil and other anti-influenza drugs among outpatients with influenza virus infection: A retrospective cohort study using an employment-based health insurance claims database in Japan. Pharmacoepidemiol Drug Saf 2021; 31:623-631. [PMID: 34881477 PMCID: PMC9303239 DOI: 10.1002/pds.5392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 12/21/2022]
Abstract
Purpose Alerts for bleeding events are included in the Japanese package inserts of some anti‐influenza drugs, including baloxavir marboxil and oseltamivir. However, there are few reports on the incidence of bleeding events during treatment with anti‐influenza drugs. This large‐scale quantitative assessment compared the incidence of bleeding events in influenza patients treated with baloxavir and other anti‐influenza drugs and in untreated patients. Methods This retrospective cohort study used a large‐scale Japanese employment‐based health insurance claims database provided by JMDC Inc. and included outpatients diagnosed with influenza between October 1, 2018 and April 11, 2019. Bleeding events were identified by International Classification of Diseases 10th revision codes. Incidences were compared between patients treated with baloxavir or neuraminidase inhibitors and untreated patients. Odds ratios were calculated after exact matching to adjust for potential confounders. Results Among 529 201 influenza episodes, 30 964 were untreated and 498 237 were treated with anti‐influenza drugs: baloxavir, 207 630; oseltamivir, 143 722; zanamivir, 28 208; peramivir, 5304; laninamivir, 113 373. Crude incidence proportions for total bleeding up to 20 days after influenza diagnosis were similar among treated groups, with a slightly higher value for peramivir (0.21% vs. 0.19% for baloxavir, oseltamivir, zanamivir, and laninamivir), and 0.30% in untreated patients. After exact matching, the incidence of bleeding for baloxavir was similar to that for other anti‐influenza treatments (odds ratios for baloxavir were 0.90–0.99 compared to other therapies). Conclusions Based on real‐world observation using a large‐scale claims database, a similar incidence of bleeding events was observed in recipients of the different anti‐influenza drugs.
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Affiliation(s)
- Azusa Hara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | | | - Takuji Komeda
- Shionogi Pharmacovigilance Center Co., Ltd., Osaka, Japan
| | | | | | | | | | | | - Hisashi Urushihara
- Division of Drug Development and Regulatory Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
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Okada A, Ono S, Yamaguchi S, Yamana H, Ikeda Kurakawa K, Michihata N, Matsui H, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. Association between nutritional guidance or ophthalmological examination and discontinuation of physician visits in patients with newly diagnosed diabetes: A retrospective cohort study using a nationwide database. J Diabetes Investig 2021; 12:1619-1631. [PMID: 33459533 PMCID: PMC8409872 DOI: 10.1111/jdi.13510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS/INTRODUCTION Discontinuation of diabetes care has been studied mostly in patients with prevalent diabetes and not in patients with newly diagnosed diabetes, whose dropout risk is highest. Because enrolling patients in a prospective study will influence adherence, we retrospectively examined whether guideline-recommended practices, defined as nutritional guidance or ophthalmological examination, can prevent patient discontinuation of diabetes care after its initiation. MATERIALS AND METHODS We retrospectively identified adults with newly screened diabetes during checkups using a large Japanese administrative claims database (JMDC, Tokyo, Japan) that contains laboratory data and lifestyle questionnaires. We defined discontinuation of physician visits as a follow-up interval exceeding 6 months. We divided the patients into those who received guideline-recommended practices (nutritional guidance or ophthalmology consultation) within the same month as the first visit and those who did not. We calculated propensity scores and carried out inverse probability of treatment weighting analyses to compare discontinuation between the two groups. RESULTS We identified 6,508 patients with at least one physician consultation for diabetes care within 3 months after their checkup, including 4,574 patients without and 1,934 with guideline-recommended practices. After inverse probability of treatment weighting, patients with guideline-recommended practices had a significantly lower proportion of discontinuation than those without (17.2% vs 21.8%; relative risk 0.79, 95% confidence interval 0.69-0.91). CONCLUSIONS This study is the first to show that after adjustment for both patient and healthcare provider factors, guideline-recommended practices within the first month of physician consultation for diabetes care can decrease subsequent discontinuation of physician visits in patients with newly diagnosed diabetes.
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Grants
- 19AA2007 Ministry of Health, Labor and Welfare, Japan
- 20K18957 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 20H03907 Ministry of Education, Culture, Sports, Science and Technology, Japan
- 17H05077 Ministry of Education, Culture, Sports, Science and Technology, Japan
- Japan Diabetes Society
- Ministry of Health, Labor and Welfare, Japan
- Japan Diabetes Society
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Sachiko Ono
- Department of Eat‐loss MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hayato Yamana
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- Department of Health Services ResearchGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsThe University of TokyoTokyoJapan
| | - Masaomi Nangaku
- Division of Nephrology and EndocrinologyGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and MetabolismGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsThe University of TokyoTokyoJapan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle‐Related DiseasesGraduate School of MedicineThe University of TokyoTokyoJapan
- Toranomon HospitalTokyoJapan
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朱 欣, 刘 小, 王 小, 杨 亚. [A clinical study of influenza A virus infection with neurological symptoms in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:451-455. [PMID: 34020732 PMCID: PMC8140337 DOI: 10.7499/j.issn.1008-8830.2102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the clinical features of children with influenza A virus infection and neurological symptoms. METHODS A retrospective analysis was performed for the clinical data of children with laboratory-confirmed influenza A and neurological symptoms who were treated in Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University from January to December, 2019. RESULTS A total of 895 children were diagnosed with influenza A, among whom 291 had neurological symptoms. Boys had a significantly higher incidence rate of influenza A than girls (P < 0.05), and the children aged 1-3 years had a significantly higher incidence rate than the other age groups (P < 0.05). Common neurological symptoms included seizures (97.3%), vomiting (24.1%), and headache (7.2%). Febrile seizures were the most common type of seizures, accounting for 88%. There was no significant difference in the time from disease onset to seizures and frequency seizures between the children with a history of febrile seizures and those without such history (P > 0.05). Of all the children, 3 were diagnosed with acute necrotizing encephalopathy (ANE), all of whom were girls and suffered seizures; the time from the first seizures to the occurrence of disturbance of consciousness was 0-7 hours, and 2 girls died within 2 days after disease onset. All children, except 2 who died of ANE and 1 with neurological sequelae, were cured. CONCLUSIONS There is a high incidence rate of neurological symptoms in children with influenza A, and seizures are the most common symptom. Most of the patients with neurological symptoms tend to have a good prognosis, but those with ANE may have a poor prognosis.
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Affiliation(s)
- 欣欣 朱
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 小乖 刘
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 小燕 王
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 亚荣 杨
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
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Chang TS, Ding Y, Freund MK, Johnson R, Schwarz T, Yabu JM, Hazlett C, Chiang JN, Wulf DA, Geschwind DH, Butte MJ, Pasaniuc B. Pre-existing conditions in Hispanics/Latinxs that are COVID-19 risk factors. iScience 2021; 24:102188. [PMID: 33615196 PMCID: PMC7879099 DOI: 10.1016/j.isci.2021.102188] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/02/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has exposed health care disparities in minority groups including Hispanics/Latinxs (HL). Studies of COVID-19 risk factors for HL have relied on county-level data. We investigated COVID-19 risk factors in HL using individual-level, electronic health records in a Los Angeles health system between March 9, 2020, and August 31, 2020. Of 9,287 HL tested for SARS-CoV-2, 562 were positive. HL constituted an increasing percentage of all COVID-19 positive individuals as disease severity escalated. Multiple risk factors identified in Non-Hispanic/Latinx whites (NHL-W), like renal disease, also conveyed risk in HL. Pre-existing nonrheumatic mitral valve disorder was a risk factor for HL hospitalization but not for NHL-W COVID-19 or HL influenza hospitalization, suggesting it may be a specific HL COVID-19 risk. Admission laboratory values also suggested that HL presented with a greater inflammatory response. COVID-19 risk factors for HL can help guide equitable government policies and identify at-risk populations.
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Affiliation(s)
- Timothy S. Chang
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Yi Ding
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Malika K. Freund
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ruth Johnson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Tommer Schwarz
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Julie M. Yabu
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chad Hazlett
- Department of Political Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Statistics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Jeffrey N. Chiang
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - David A. Wulf
- Department of Political Science, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel H. Geschwind
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Institute of Precision Health, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Manish J. Butte
- Divisions of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Bogdan Pasaniuc
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Yamana H, Ono S, Michihata N, Jo T, Yasunaga H. Association between Maoto Use and Hospitalization for Seasonal Influenza in a Nonelderly Cohort in Japan. Intern Med 2021; 60:3401-3408. [PMID: 34719625 PMCID: PMC8627799 DOI: 10.2169/internalmedicine.6416-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Maoto is a traditional Japanese Kampo formula used to treat influenza. However, clinical evidence for maoto has been limited to small-scale studies of its effect in alleviating symptoms. The present study evaluated whether or not the addition of maoto to a neuraminidase inhibitor was associated with a reduction in hospitalization following influenza. Methods Using the JMDC Claims Database, we identified outpatients <60 years old who were diagnosed with influenza by an antigen test from September 2013 to August 2018. One-to-five propensity score matching was conducted between patients who received maoto in addition to a neuraminidase inhibitor and those who received a neuraminidase inhibitor alone. Hospitalization within seven days of the influenza diagnosis was compared in the matched groups using the Mantel-Haenszel test. Results We identified 1.79 million cases of influenza from the database in the 5-year study period. Maoto was prescribed for 3.9% of the 1.67 million cases receiving a neuraminidase inhibitor. In the 64,613 propensity score-matched groups of patients, the 7-day hospitalization rate was 0.116% (n=75) for patients with maoto and 0.122% (n=394) for patients without maoto. The difference between these treatment groups was nonsignificant (common odds ratio, 0.95; 95% confidence interval, 0.74 to 1.22; p=0.695). Conclusion The addition of maoto to a neuraminidase inhibitor was not associated with a decrease in hospitalization among nonelderly patients with influenza. Further research is necessary to clarify the indication and efficacy of maoto.
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Affiliation(s)
- Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
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Komeda T, Takazono T, Hosogaya N, Miyazaki T, Ogura E, Iwata S, Miyauchi H, Honda K, Fujiwara M, Ajisawa Y, Watanabe H, Kitanishi Y, Hara K, Mukae H. Comparison of Hospitalization Incidence in Influenza Outpatients Treated With Baloxavir Marboxil or Neuraminidase Inhibitors: A Health Insurance Claims Database Study. Clin Infect Dis 2020; 73:e1181-e1190. [PMID: 33354728 PMCID: PMC8423480 DOI: 10.1093/cid/ciaa1870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background Baloxavir marboxil (baloxavir) is a single-dose, oral antiinfluenza drug with a novel mechanism of action. We compared the incidence of hospitalization in patients treated with baloxavir vs neuraminidase inhibitors. Methods In this retrospective, observational, cohort study, we used real-world patient data extracted from a Japanese health insurance claims database. The enrollment period was 1 October 2018 to 17 April 2019. On day 1, eligible patients (N = 339 007) received baloxavir, oseltamivir, zanamivir, or laninamivir. Baseline characteristics were standardized using the inverse probability of treatment weighting method. The primary end point was the incidence of hospitalization (days 2–14). Secondary end points included antibacterial use, secondary pneumonia, and additional antiinfluenza drug use. Results Compared with the baloxavir group, the incidence of hospitalization was greater in the oseltamivir group (risk ratio [RR] and 95% confidence interval [CI], 1.41 [1.00–2.00]; risk difference [RD] and 95% CI, 0.06 [.01–.12]) and zanamivir group (RR, 1.85 [1.23–2.78]; RD, 0.11 [.02–.20]). Oseltamivir-treated patients were less likely to require antibacterials than baloxavir-treated patients (RR, 0.87 [.82–.91]). However, oseltamivir-treated patients were more likely to be hospitalized with antibacterials (RR, 1.70 [1.21–2.38]) or antibacterial injection (RR, 1.67 [1.17–2.38]) than baloxavir-treated patients (post hoc analysis). Compared with baloxavir-treated patients, additional antiinfluenza drug use was greater in oseltamivir-, zanamivir-, and laninamivir-treated patients (RR, 1.51 [1.05–2.18], 2.84 [2.04–3.96], and 1.68 [1.35–2.10], respectively). Conclusions Baloxavir is an efficacious antiinfluenza treatment that may reduce hospitalization compared with oseltamivir and zanamivir. Clinical Trials Registration University hospital Medical Information Network Clinical Trials Registry (UMIN000038159).
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Affiliation(s)
- Takuji Komeda
- Shionogi Pharmacovigilance Center Co., Ltd., Osaka, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Naoki Hosogaya
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Taiga Miyazaki
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Shinpei Iwata
- Shionogi Pharmacovigilance Center Co., Ltd., Osaka, Japan
| | | | - Keiichi Honda
- Shionogi Pharmacovigilance Center Co., Ltd., Osaka, Japan
| | | | | | | | | | | | - Hiroshi Mukae
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, Yao L, Motaghi S, Couban RJ, Ghadimi M, Bala MM, Gomaa H, Fang F, Xiao Y, Guyatt GH. Efficacité et innocuité des corticostéroïdes dans le traitement de la COVID-19 selon des données pour la COVID-19, d’autres infections aux coronavirus, l’influenza, la pneumonie extrahospitalière et le syndrome de détresse respiratoire aiguë : revue systématique et méta-analyse. CMAJ 2020; 192:E1571-E1584. [PMID: 33229355 DOI: 10.1503/cmaj.200645-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zhikang Ye
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Ying Wang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Luis Enrique Colunga-Lozano
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Manya Prasad
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Wimonchat Tangamornsuksan
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Bram Rochwerg
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Liang Yao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Shahrzad Motaghi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Rachel J Couban
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Maryam Ghadimi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Malgorzata M Bala
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Huda Gomaa
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Fang Fang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Yingqi Xiao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Gordon H Guyatt
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
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Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, Yao L, Motaghi S, Couban RJ, Ghadimi M, Bala MM, Gomaa H, Fang F, Xiao Y, Guyatt GH. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2020; 192:E756-E767. [PMID: 32409522 DOI: 10.1503/cmaj.200645] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Very little direct evidence exists on use of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Indirect evidence from related conditions must therefore inform inferences regarding benefits and harms. To support a guideline for managing COVID-19, we conducted systematic reviews examining the impact of corticosteroids in COVID-19 and related severe acute respiratory illnesses. METHODS We searched standard international and Chinese biomedical literature databases and prepublication sources for randomized controlled trials (RCTs) and observational studies comparing corticosteroids versus no corticosteroids in patients with COVID-19, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). For acute respiratory distress syndrome (ARDS), influenza and community-acquired pneumonia (CAP), we updated the most recent rigorous systematic review. We conducted random-effects meta-analyses to pool relative risks and then used baseline risk in patients with COVID-19 to generate absolute effects. RESULTS In ARDS, according to 1 small cohort study in patients with COVID-19 and 7 RCTs in non-COVID-19 populations (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.55 to 0.93, mean difference 17.3% fewer; low-quality evidence), corticosteroids may reduce mortality. In patients with severe COVID-19 but without ARDS, direct evidence from 2 observational studies provided very low-quality evidence of an increase in mortality with corticosteroids (hazard ratio [HR] 2.30, 95% CI 1.00 to 5.29, mean difference 11.9% more), as did observational data from influenza studies. Observational data from SARS and MERS studies provided very low-quality evidence of a small or no reduction in mortality. Randomized controlled trials in CAP suggest that corticosteroids may reduce mortality (RR 0.70, 95% CI 0.50 to 0.98, 3.1% lower; very low-quality evidence), and may increase hyperglycemia. INTERPRETATION Corticosteroids may reduce mortality for patients with COVID-19 and ARDS. For patients with severe COVID-19 but without ARDS, evidence regarding benefit from different bodies of evidence is inconsistent and of very low quality.
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Affiliation(s)
- Zhikang Ye
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Ying Wang
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Luis Enrique Colunga-Lozano
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Manya Prasad
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Wimonchat Tangamornsuksan
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Rachel J Couban
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Malgorzata M Bala
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Huda Gomaa
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Fang Fang
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
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Lansbury LE, Rodrigo C, Leonardi-Bee J, Nguyen-Van-Tam J, Shen Lim W. Corticosteroids as Adjunctive Therapy in the Treatment of Influenza: An Updated Cochrane Systematic Review and Meta-analysis. Crit Care Med 2020; 48:e98-e106. [PMID: 31939808 DOI: 10.1097/ccm.0000000000004093] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Corticosteroids may be beneficial in sepsis, but uncertainty remains over their effects in severe influenza. This systematic review updates the current evidence regarding corticosteroids in the treatment of influenza and examines the effect of dose on outcome. DATA SOURCES Electronic databases (MEDLINE, EMBASE, CINAHL, LILACS, CENTRAL, and Web of Science) and trial registries were searched to October 2018 for randomized controlled trials, quasi-experimental designs, and observational cohort studies reporting corticosteroid versus no corticosteroid treatment in individuals with influenza. STUDY SELECTION AND DATA EXTRACTION Two researchers independently assessed studies for inclusion. Risk of bias was assessed using the Cochrane Risk of Bias tool (randomized controlled trials) or Newcastle-Ottawa Scale (observational studies). Where appropriate, we estimated the effect of corticosteroids by random-effects meta-analyses using the generic inverse variance method. Meta-regression analysis was used to assess the association of corticosteroid dose and mortality. DATA SYNTHESIS We identified 30 eligible studies, all observational apart from one randomized controlled trial. Twenty-one observational studies were included in the meta-analysis of mortality, which suggested an adverse association with corticosteroid therapy (odds ratio, 3.90; 95% CI, 2.31-6.60; 15 studies; adjusted hazard ratio, 1.49; 95% CI, 1.09-2.02; six studies). Risk of bias assessment was consistent with potential confounding by indication. Pooled analysis of seven studies showed increased odds of hospital-acquired infection in people treated with corticosteroids (unadjusted odds ratio, 2.74; 95% CI, 1.51-4.95). Meta-regression of the effect of dose on mortality did not reveal an association, but reported doses of corticosteroids in included studies were high (mostly > 40 mg methylprednisolone [or equivalent] per day). CONCLUSIONS Corticosteroid treatment in influenza is associated with increased mortality and hospital-acquired infection, but the evidence relates mainly to high corticosteroid doses and is of low quality with potential confounding by indication a major concern.
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Affiliation(s)
- Louise E Lansbury
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre NIHR, United Kingdom
| | - Chamira Rodrigo
- Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Jonathan Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Wei Shen Lim
- Nottingham Biomedical Research Centre NIHR, United Kingdom
- Department of Respiratory Medicine, Nottingham University Hospitals Trust, Nottingham, United Kingdom
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Lansbury L, Rodrigo C, Leonardi‐Bee J, Nguyen‐Van‐Tam J, Lim WS. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev 2019; 2:CD010406. [PMID: 30798570 PMCID: PMC6387789 DOI: 10.1002/14651858.cd010406.pub3] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefits or harms. This is an update of a review first published in 2016. OBJECTIVES To systematically assess the effectiveness and potential adverse effects of corticosteroids as adjunctive therapy in the treatment of influenza, taking into account differences in timing and doses of corticosteroids. SEARCH METHODS We searched CENTRAL (2018, Issue 9), which includes the Cochrane Acute Respiratory infections Group's Specialised Register, MEDLINE (1946 to October week 1, 2018), Embase (1980 to 3 October 2018), CINAHL (1981 to 3 October 2018), LILACS (1982 to 3 October 2018), Web of Science (1985 to 3 October 2018), abstracts from the last three years of major infectious disease and microbiology conferences, and references of included articles. We also searched the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry on 3 October 2018. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and observational studies that compared corticosteroid treatment with no corticosteroid treatment for influenza or influenza-like illness. We did not restrict studies by language of publication, influenza subtypes, clinical setting, or age of participants. We selected eligible studies in two stages: sequential examination of title and abstract, followed by full text. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We pooled estimates of effect using a random-effects model, where appropriate. We assessed heterogeneity using the I2 statistic and assessed the certainty of the evidence using the GRADE framework. MAIN RESULTS This updated review includes 30 studies (one RCT with two arms and 29 observational studies) with a total of 99,224 participants. We included 19 studies in the original review (n = 3459), all of which were observational, with 13 studies included in the meta-analysis for mortality. We included 12 new studies in this update (one RCT and 11 observational studies), and excluded one study in the original review as it has been superceded by a more recent analysis. Twenty-one studies were included in the meta-analysis (9536 individuals), of which 15 studied people infected with 2009 influenza A H1N1 virus (H1N1pdm09). Data specific to mortality were of very low quality, based predominantly on observational studies, with inconsistent reporting of variables potentially associated with the outcomes of interest, differences between studies in the way in which they were conducted, and with the likelihood of potential confounding by indication. Reported doses of corticosteroids used were high, and indications for their use were not well reported. On meta-analysis, corticosteroid therapy was associated with increased mortality (odds ratio (OR) 3.90, 95% confidence interval (CI) 2.31 to 6.60; I2 = 68%; 15 studies). A similar increase in risk of mortality was seen in a stratified analysis of studies reporting adjusted estimates (OR 2.23, 95% CI 1.54 to 3.24; I2 = 0%; 5 studies). An association between corticosteroid therapy and increased mortality was also seen on pooled analysis of six studies which reported adjusted hazard ratios (HRs) (HR 1.49, 95% CI 1.09 to 2.02; I2 = 69%). Increased odds of hospital-acquired infection related to corticosteroid therapy were found on pooled analysis of seven studies (pooled OR 2.74, 95% CI 1.51 to 4.95; I2 = 90%); all were unadjusted estimates, and we graded the data as of very low certainty. AUTHORS' CONCLUSIONS We found one RCT of adjunctive corticosteroid therapy for treating people with community-acquired pneumonia, but the number of people with laboratory-confirmed influenza in the treatment and placebo arms was too small to draw conclusions regarding the effect of corticosteroids in this group, and we did not include it in our meta-analyses of observational studies. The certainty of the available evidence from observational studies was very low, with confounding by indication a major potential concern. Although we found that adjunctive corticosteroid therapy is associated with increased mortality, this result should be interpreted with caution. In the context of clinical trials of adjunctive corticosteroid therapy in sepsis and pneumonia that report improved outcomes, including decreased mortality, more high-quality research is needed (both RCTs and observational studies that adjust for confounding by indication). The currently available evidence is insufficient to determine the effectiveness of corticosteroids for people with influenza.
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Affiliation(s)
- Louise Lansbury
- The University of NottinghamDepartment of Epidemiology and Public HealthCity Hospital CampusHucknall RoadNottinghamUKNG5 1PB
| | - Chamira Rodrigo
- Nottingham University Hospitals TrustDepartment of Respiratory MedicineCity CampusHucknall RoadNottinghamNottinghamshireUKNG5 1PB
| | - Jo Leonardi‐Bee
- The University of NottinghamDivision of Epidemiology and Public HealthClinical Sciences BuildingNottingham City Hospital NHS Trust Campus, Hucknall RoadNottinghamUKNG5 1PB
| | - Jonathan Nguyen‐Van‐Tam
- The University of NottinghamFaculty of Medicine and Health SciencesRoom A40DClinical Sciences Building City Hospital Campus, Hucknall RoadNottinghamNottinghamshireUKNG5 1PB
| | - Wei Shen Lim
- Nottingham University Hospitals TrustDepartment of Respiratory MedicineCity CampusHucknall RoadNottinghamNottinghamshireUKNG5 1PB
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Ishimaru M, Ono S, Matsui H, Yasunaga H. Association between perioperative oral care and postoperative pneumonia after cancer resection: conventional versus high-dimensional propensity score matching analysis. Clin Oral Investig 2019; 23:3581-3588. [PMID: 30623308 DOI: 10.1007/s00784-018-2783-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Perioperative oral care was reported to decrease postoperative pneumonia after cancer resections. However, the effect remains controversial because previous studies were limited due to their small sample sizes and lack of strict control for patient backgrounds. The present study evaluated the association between perioperative oral care and postoperative pneumonia using high-dimensional propensity score (hd-PS) matching to adjust for confounding factors. MATERIALS AND METHODS Using a Japanese health insurance claims database, we identified patients who underwent surgical treatment of cancer from April 2014 to March 2015. To compare outcomes (postoperative pneumonia and procedure-related complications) between patients with and without perioperative oral care, we performed hd-PS matching and conventional PS matching and chi-square test. RESULTS We identified 621 patients with oral care and 4374 patients without oral care. The occurrences of postoperative pneumonia were not significantly different between patients with and without oral care in the unmatched (2.9% vs. 3.2%), conventional PS-matched (2.9% vs. 2.9%), or hd-PS-matched (2.9% vs. 3.3%) groups. The occurrences of procedure-related complication were not significantly different between patients with and without oral care in the unmatched (23.8% vs. 24.5%), conventional PS-matched (23.8% vs. 26.4%), or hd-PS-matched (24.4% vs. 27.7%) groups. CONCLUSIONS There was no significant difference in postoperative pneumonia or procedure-related complications between patients with and without perioperative oral care. CLINICAL RELEVANCE While maintaining optimal oral care in cancer patients is an important goal, the present study revealed no significant difference in postoperative outcomes. Further investigations would be needed to determine the effect of perioperative oral care.
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Affiliation(s)
- Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Sachiko Ono
- Department of Biostatistics & Bioinformatics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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16
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Powers JH, Bacci ED, Guerrero ML, Leidy NK, Stringer S, Kim K, Memoli MJ, Han A, Fairchok MP, Chen WJ, Arnold JC, Danaher PJ, Lalani T, Ridoré M, Burgess TH, Millar EV, Hernández A, Rodríguez-Zulueta P, Smolskis MC, Ortega-Gallegos H, Pett S, Fischer W, Gillor D, Macias LM, DuVal A, Rothman R, Dugas A, Ruiz-Palacios GM. Reliability, Validity, and Responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) Scores in Influenza-Positive Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:210-218. [PMID: 29477403 PMCID: PMC5831548 DOI: 10.1016/j.jval.2017.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the reliability, validity, and responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) scores for quantifying the presence and severity of influenza symptoms. METHODS An observational prospective cohort study of adults (≥18 years) with influenza-like illness in the United States, the United Kingdom, Mexico, and South America was conducted. Participants completed the 37-item draft FLU-PRO daily for up to 14 days. Item-level and factor analyses were used to remove items and determine factor structure. Reliability of the final tool was estimated using Cronbach α and intraclass correlation coefficients (2-day reliability). Convergent and known-groups validity and responsiveness were assessed using global assessments of influenza severity and return to usual health. RESULTS Of the 536 patients enrolled, 221 influenza-positive subjects comprised the analytical sample. The mean age of the patients was 40.7 years, 60.2% were women, and 59.7% were white. The final 32-item measure has six factors/domains (nose, throat, eyes, chest/respiratory, gastrointestinal, and body/systemic), with a higher order factor representing symptom severity overall (comparative fit index = 0.92; root mean square error of approximation = 0.06). Cronbach α was high (total = 0.92; domain range = 0.71-0.87); test-retest reliability (intraclass correlation coefficient, day 1-day 2) was 0.83 for total scores and 0.57 to 0.79 for domains. Day 1 FLU-PRO domain and total scores were moderately to highly correlated (≥0.30) with Patient Global Rating of Flu Severity (except nose and throat). Consistent with known-groups validity, scores differentiated severity groups on the basis of global rating (total: F = 57.2, P < 0.001; domains: F = 8.9-67.5, P < 0.001). Subjects reporting return to usual health showed significantly greater (P < 0.05) FLU-PRO score improvement by day 7 than did those who did not, suggesting score responsiveness. CONCLUSIONS Results suggest that FLU-PRO scores are reliable, valid, and responsive to change in influenza-positive adults.
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Affiliation(s)
- John H Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, USA.
| | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Matthew J Memoli
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Alison Han
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mary P Fairchok
- Madigan Army Medical Center, Fort Lewis, WA, USA; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | | | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; Naval Medical Center, Portsmouth, VA, USA
| | | | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sarah Pett
- University College London, London, UK; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Anna DuVal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
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