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Tamiflu's Effectiveness Doubted

Expert Analysis Concludes Antiviral Drug May Not Prevent Complications in Healthy People
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WebMD Health News

Dec. 9, 2009 -- Widely used antiviral drugs such as Tamiflu and Relenza may not prevent complications such as pneumonia in healthy people, according to a new investigation and analysis.

"We're not so sure the drugs are so magic a bullet as we previously thought," researcher Chris Del Mar, MD, dean of medicine at Bond University in Australia, tells WebMD. He is the coordinating editor of the Cochrane Acute Respiratory Infections Group and headed the research team that analyzed 20 published trials that focused on prevention, treatment, and adverse reactions of the antiviral drugs against the flu, known as neuraminidase inhibitors. The Cochrane Collection regularly updates evidence for and against the effectiveness of specific treatments.

The study is published in BMJ Online First, and the investigation developed into a joint project of BMJ and the U.K.'s Channel 4 news.

"Cochrane decided to update all the reviews that might inform influenza management," Del Mar tells WebMD. The use of the drugs has increased dramatically since the swine flu pandemic began in April 2009. Worldwide, governments have stockpiled Tamiflu to prepare for a pandemic.

The investigation, Del Mar says, was hampered by a scarcity of good data from the authors of the study and from Roche, the company that makes Tamiflu.

But Roche, in a statement, says it stands behind the integrity of the data, which supports the use and effectiveness of Tamiflu.

Tamiflu Effective? Review Details

Del Mar's team set out to update a 2005 Cochrane Library review that evaluated the effect of the drugs in preventing or improving influenza symptoms, transmission of the flu, and complications from the flu in healthy people and to estimate the effect of adverse effects.

"We found that the information we had wasn't as good as we initially thought when we first did the review," Del Mar says. "We were surprised at how poor the data [was ] on adverse effects."

They concluded that the neuraminidase inhibitors have "modest effectiveness against the symptoms of influenza in otherwise healthy adults." The drugs reduce the duration of illness by about a day.

"This benefit has been generalized to assume benefit for very ill people in hospital," the authors write. Although this seems reasonable, they say they have no data to support this.

The data on the effectiveness of Tamiflu against complications of the flu are "confusing," the researchers write. The researchers had to drop eight trials that were never fully published, although they were included in the previous review. But the researchers dropped them for this review because they could not verify the results independently.

Del Mar's bottom-line advice for healthy people? "Don't take [the antivirals] to prevent complications because we don’t have enough good data for that. It reduces the [duration of the] illness by one day. So you have to make a decision about whether it’s worth it or not."

A viable alternative, he tells WebMD, may be to take acetaminophen or "lemon sips" -- a hot lemon drink.

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