A study that calls into question the stockpiling of billions of dollars' worth of antiviral drugs to mitigate the threat of influenza pandemics has been criticized by flu researchers.
The analysis of Tamiflu and Relenza, drugs known as neuraminidase inhibitors, was published on 10 April by the Cochrane Collaboration (1), a group that reviews the effectiveness of health-care measures. It concluded that the medicines were of little use. At the same time, the journal BMJ published a series of articles, including two that summarize the Cochrane findings (2,3), and several editorials that focus on the five-year campaign by Cochrane and the BMJ to obtain the unpublished drug-company clinical-trial data later used in the review.
The results "challenge the historical assumption that neuraminidase inhibitors are effective in combating influenza", declared a joint BMJ-Cochrane news release on the findings. The drugs have had their "effectiveness overplayed, and harms underplayed", said Fiona Godlee, the BMJs editor-in-chief, at a press conference. The study generated worldwide media coverage, including headlines labelling Tamiflu as "useless" and "ineffective".
But the review and its bottom line are vigorously contested by many flu researchers. They argue that the analysis--an update by Cochrane--is based on randomized clinical trials (RCTs) of the drugs that lack sufficient statistical power to allow reliable conclusions to be drawn about the effects on flu complications and hospitalizations. These are the key outcomes of interest during a flu pandemic.
The critics say that the review also excluded many observational studies that have found the drugs to be helpful in normal clinical settings.
Tamiflu is prescribed as the main treatment for serious cases of flu, and researchers worry that...
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