TAMIFLU: BE CAREFUL, LEST BE MISLED

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Igho Onakpoya

If you wanted to conduct an independent assessment of the clinical usefulness of a drug, would it be wise to use funds from the drug manufacturer to perform the research?

Since we published our Cochrane review last year (the most comprehensive assessment of data from Tamiflu clinical trials) highlighting issues with the safety and effectiveness of neuraminidase inhibitors in the prevention and treatment of influenza, several subsequent reviews have begun to appear in the scientific literature. Largely, they have sought to amplify Tamiflu’s effectiveness and debunk some of the findings in our report.

Of note, these reviews have tended to highlight the fact that Tamiflu reduces the time to first alleviation of influenza symptoms, when compared with dummy pills. The reports also claim that Tamiflu decreases the risk of acquiring respiratory infections.

In the last few hours, another such review has been published; only this time it is a combination of published and unpublished trials, with additional individual patient data obtained from Tamiflu manufacturers. The authors reported that Tamiflu reduces the time to first alleviation of symptoms (this virtually all reports have agreed with).

The authors of the report concluded that taking Tamiflu reduces the risk of contracting lower respiratory infections compared with dummies. However, they have lumped both bronchitis and pneumonia together, and have avoided reporting their incidence separately. The favourable outcome with Tamiflu use was favoured by a larger number of participants with dummy pills having bronchitis. However, acute bronchitis rarely requires the use of antibiotics in clinical practice – you only need to take paracetamol or ibuprofen with lots of fluids.

Furthermore, the authors conclude that Tamiflu has no serious adverse effects. This is contrary to our Cochrane review and another review of FDA Adverse Event Reporting System data (BMJ2013;347:f4656) which support evidence of unwanted psychiatric reactions to Tamiflu.

What is most puzzling is that the newly published review was reportedly funded by the Multiparty Group for Advice on Science (MUGAS), who in turn got all their funding from Roche. In addition, one half of the authors of report have received funding from Roche.

So I ask: whose report would you believe?

Igho Onakpoya

About Igho Onakpoya

Research Fellow in Evidence Based Practice and Pharmacovigilance

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One comment on “TAMIFLU: BE CAREFUL, LEST BE MISLED

  1. I have some problems with the article by Heath Kelly and Benjamin Cowling at thttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60074-5/fulltext
    Entitled Influenza: the rational use of oseltamivir which has been triggered by the publication of the Dobson paper in the lancet on 30.1.15
    Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62449-1/fulltext

    The Kelly and Cowling article claims that the re-analysis was done by an independent research group
    However one of the 4 authors RJW is a director of Gilead Sciences which holds the patent for Oseltamivir
    See http://www.gilead.com/about/leadership/board-of-directors

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