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In Reply We appreciate the interest generated by our Viewpoint.1
In their Cochrane review,2 Jefferson and Doshi have conducted a thorough and rigorous analysis of the available randomized clinical trial (RCT) data. However, the authors themselves acknowledge the limitations of their conclusions given the quality of the studies reviewed, stating: “Hospitalizations are an important but poorly defined outcome in the oseltamivir protocols, inconsistently reported in the clinical study reports and overlooked in the zanamivir protocols and reports. The oseltamivir trials did not detect any influenza-related deaths, reflecting the relatively benign nature of influenza in the study populations.”2 Cochrane reviews set rigorous standards for deciding which studies to include, preferentially including RCTs over observational studies, and typically result in conservative recommendations. However, the inability to show benefit under the most rigorous study conditions does not mean that benefit does not exist.3 Given this, it is reasonable to consider the available non-RCT data when evaluating the usefulness of neuraminidase inhibitor drugs (NAI) for influenza.
Louie JK, Lampiris H. Neuraminidase Inhibitors and Influenza Infection—Reply. JAMA Intern Med. 2016;176(3):416-417. doi:10.1001/jamainternmed.2016.0050