770. The Influenza Resistance Information Study (IRIS): Results of Treatment in 2009-H1N1 Influenza A-Infected Patients
Session: Abstracts: Virology: Influenza
Friday, October 22, 2010
Background: To examine clinical outcomes and resistance patterns with neuraminidase inhibitor (NAI) treatment in 2009-H1N1 influenza A infection.

Methods: Patients with RT-PCR confirmed 2009-H1N1 infection provided informed consent and were enrolled from centers in Asia, Europe and the USA. Patient disposition, symptom score (using a daily patient diary card and physician assessment at baseline and day 10) and body temperature were recorded. Nasopharyngeal samples were collected at baseline and days 3, 6 and 10 for virologic analysis.

Results: Of 339 participants, 172 received NAI (167 oseltamivir, 5 zanamivir) and 167 did not. Those at high risk for influenza complications included children <5 years (21%) and obese patients (7% with BMI 30–47.5). Total symptom scores decreased from day 1 (11.6 and 12.1 for the non-treated and treated groups, respectively) to day 10 (1.8 and 1.5, respectively), with no serious complications in either group. Differences in disease resolution were not significant between groups. Body temperature decreased in both groups from day 1 (mean 38.3°C [range 36.0–40.5°C] and 38.2°C [range 35.3–40.3°C] for non-treated and treated patients, respectively) to day 10 (mean 36.7°C [range 35.1–37.8°C] and 36.6°C [range 34.3–38.1°C], respectively). Total symptom score and mean body temperature remained comparable between the groups over the illness course. Influenza virus became undetectable on day 3 and 6 by RT-PCR in a higher proportion of treated (21.2 and 73.1%, respectively) versus non-treated patients (13.2 and 60.9%, respectively). One 2-year-old patient who received oseltamivir before trial entry had a genotypic (275Y) virus in the day 1 sample, which became undetectable on day 3. Otherwise, no genotypic or phenotypic resistance to NAI was detected in the overall population.

Conclusion: 2009-H1N1 influenza A induced a relatively mild disease. NAI treatment was well tolerated and resulted in faster virus clearance compared to those not treated, without resistance development.


Subject Category: A. Antimicrobial agents and Resistance

Speakers:
Martin Schutten , Erasmus Medical Centre, Rotterdam, Netherlands
Charles Boucher , Erasmus Medical Centre, Rotterdam, Netherlands
Bruno Lina , University of Lyon, Lyon, France
Arnold Monto, MD , University of Michigan, Ann Arbor, MI
Albert Osterhaus , Erasmus Medical Centre, Rotterdam, Netherlands
Jonathan Nguyen-Van-Tam , University of Nottingham, Nottingham, United Kingdom
Richard J. Whitley, MD, FIDSA , Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL

Disclosures:

M. Schutten, Yes
F. Hoffmann-La Roche: Consultant and Grant Investigator,

C. Boucher, Yes
GlaxoSmithKline: Consultant,
Merck: Research Contractor and Scientific Advisor,
F. Hoffmann-La Roche: Research Contractor,
ESPID: Member,

B. Lina, Yes
F. Hoffmann-La Roche: Board Member, Consultant and Scientific Advisor,
Biocryst: DMC for clinical trials,
GlaxoSmithKline: Board Member,
Sanofi Pasteur: Consultant,

A. Monto, Yes
F. Hoffmann-La Roche: Consultant and Scientific Advisor,
GlaxoSmithKline: Consultant, Lecturer and Scientific Advisor,
Novartis: Consultant and Scientific Advisor,
Biocryst: Consultant and Scientific Advisor,
Sanofi Pasteur: Grant Investigator,

A. Osterhaus, Yes
F. Hoffmann-La Roche: Consultant and Grant Investigator,
Viroclinics Biosciences: Employee and Shareholder,
CoroNovative: Shareholder,
Isconova: Shareholder,
GlaxoSmithKline: Consultant and Investigator,
Baxter: Consultant,
Novartis: Consultant,
MedImmune: Consultant,
Sanofi Pasteur: Consultant,
Solvay: Consultant,

J. Nguyen-Van-Tam, Yes
F. Hoffmann-La Roche: Collaborator and Scientific Advisor,
GlaxoSmithKline: Grant Investigator, Scientific Advisor, Speaker's Bureau and Trainer,
Baxter: Scientific Advisor, Speaker's Bureau and Trainer,
Solvay: Grant referee and Scientific Advisor,

R. J. Whitley, None

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