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Therapeutics
Zanamivir speeds symptom relief in influenza

https://doi.org/10.1136/ebm.5.3.80

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    (1999) J Infect Dis 180, 254. Monto AS, Fleming DM, Henry D, et al.. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza A and B virus infections.. Aug;. :. –61.
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 QUESTION: In patients with symptoms of influenza, what is the clinical efficacy and safety of zanamivir?

    Design

    Randomised {allocation concealed*}†, blinded (clinicians and patients),* placebo controlled trial with 21 day follow up.

    Setting

    Clinical centres in North America and Europe.

    Patients

    1256 patients (mean age 35 y, 66% women) who presented with symptoms of influenza of ≤48 hours of duration during 1 influenza season: fever and ≥2 of myalgia, headache, cough, or sore throat. Exclusion criteria were unstable chronic illness, receipt of other antiviral agents in the previous 7 days, inability to use inhaler devices satisfactorily, known or suspected hypersensitivity to study medication, pregnancy, lactation, or potential for pregnancy. 1182 patients (94%) completed the study.

    Intervention

    Patients were allocated to 5 days of treatment with zanamivir, 10 mg by oral inhalation and 6.4 mg by nasal spray 2 times/day (n=419); zanamivir (same dosages and administration routes) 4 times/day (n=415); or placebo (n=422).

    Main outcome measures

    Time to alleviation of clinical symptoms, which had to be maintained for ≥24 hours. Secondary outcomes were mean symptom score, sleep disturbance, time to return to normal activities, and use of acetaminophen and dextromethorphan to relieve symptoms.

    Main results

    Analysis was by intention to treat. Both regimens of zanamivir reduced the time to alleviation of clinical symptoms by 1 day less than placebo (6 …

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    Footnotes

    • Source of funding: GlaxoWellcome Research and Development.

    • For correspondence: Dr AS Monto, University of Michigan, School of Public Health, Department of Epidemiology, 109 Observatory Street, Ann Arbor, MI 48109, USA. Fax +1 734 764 3192.

    • ↵* See glossary.

    • ↵† Information provided by author.