Role of combination antiviral therapy in pandemic influenza and stockpiling implications

Tsiodras, Sotirios; Mooney, John D.; Hatzakis, Angelos

doi:10.1136/bmj.39105.428981.be

Cited by 18 publications

(17 citation statements)

References 21 publications

(11 reference statements)

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“…Moreover, if resistance emerges rapidly, then the expected public health benefits might not accrue. The ability of combination therapy to prevent resistance remains debatable, 14 although the ineffectiveness of adamantanes in preventing transmission, the rapid development of resistance to these drugs and probable associated harms imply that neuraminidase inhibitors will require supplementation with other drugs. 15 However, combination treatment would further stretch resources and compound logistical challenges.…”

Section: Researchmentioning

confidence: 99%

Progress and shortcomings in European national strategic plans for pandemic influenza

Mounier-Jack

Jas

Coker

2007

Bull World Health Organ

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Objective To repeat and update our previous evaluation (2005) of Europe's national pandemic influenza preparedness plans and assess the progress that has been made. Methods We assessed published national pandemic influenza preparedness plans from the European Union countries, from the two acceding countries (Bulgaria and Romania) and from Norway, Switzerland and Turkey. Plans were eligible for inclusion if formally published before 30 September 2006. We referred to WHO guidelines and used a systematically applied data extraction form. We considered plans in relation to border control measures, antiviral drugs and vaccines. Findings Twenty-nine countries had plans that were included in the analysis, compared with 21 countries in 2005. Substantial differences existed in countries' plans for border control measures, and many plans diverged from WHO guidelines. Likewise, countries' plans on antiviral drugs and vaccines varied and operational planning remained weak. Conclusion Although progress has been made in the completeness of plans, problems remain unsolved regarding national plans' divergence from international recommendations, persisting strategic incoherence and operational limitations in relation to potentially scarce resources. Border control plans also show gaps and inconsistencies, and these are likely to be politically volatile during a pandemic.

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Section: Researchmentioning

confidence: 99%

Progress and shortcomings in European national strategic plans for pandemic influenza

Mounier-Jack

Jas

Coker

2007

Bull World Health Organ

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“…Moreover several clades of the avian influenza A/H5N1 virus are resistant to adamantanes. These facts in association with the up to 50% fatality rates among NI-treated cases, highlights the need for development of novel antiviral agents and the investigation of combination anti-influenza regimens [17,18]. We review the currently available and investigational antiviral agents for seasonal, avian, novel A(H1N1) and pandemic influenza with regards to their molecular targets, resistance issues, and future use.…”

Section: Introductionmentioning

confidence: 98%

Antiviral Agents for Influenza: Molecular Targets, Concerns of Resistance, and New Treatment Options

Maltezou

Tsiodras²

2009

CDT

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As resistance of influenza viruses to antiviral agents continues to evolve, new issues arise concerning appropriate therapy and novel therapeutic means that target influenza infections. Emergence of novel influenza mutations may lead to phenotypic as well as clinical resistance that may become a problem in serious influenza cases. Moreover, crucial public health issues emerge such as appropriate antiviral stockpiling for prepandemic and pandemic phases. The use of antiviral agents against seasonal, avian, and pandemic influenza should be an integral part of current pandemic preparedness planning and should be based on local and international surveillance data on antiviral resistance. As we tackle such resistance issues there appears to be an urgent need for developing strategies to conserve current antivirals against influenza, develop new agents or formulations that will exploit current pharmacokinetic knowledge, and study combination regimens.

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“…The truth is that no single antiinfluenza drug can be seen as a panacea and antivirals should be seen as a part of a wider package of measures and options to control the potential spread of pandemic influenza, including of course the most important measure that is effective vaccination. In particular and as suggested by recent research (Tsiodras et al 2007), there may be a potential role for combination therapy, may be an appropriate solution for a pandemic in order to minimize the development of resistance to antivirals. Nevertheless, there is a need for an improved evidence base regarding the exact role for ion channel inhibitors, since no one knows what the susceptibility pattern of a pandemic influenza strain will be.…”

Section: ) Mythmentioning

confidence: 99%

“…This is due to misconceptions regarding their safety and resistance profile when compared to ion channel inhibitors like amantadine. However, neurmaninidase inhibitors are associated with important side effects and resistance is emerging even in the recent H5N1 strains (Tsiodras et al 2007). The truth is that no single antiinfluenza drug can be seen as a panacea and antivirals should be seen as a part of a wider package of measures and options to control the potential spread of pandemic influenza, including of course the most important measure that is effective vaccination.…”

Section: ) Mythmentioning

confidence: 99%

Human influenza pandemics: Myth and reality

Tsiodras

2017

J Hellenic Vet Med Soc

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This paper attempts to shed light in certain questions and false beliefs about seasonal, avian and pandemic influenza, mainly focusing on issues surrounding pandemic influenza. Important similarities and differences exist between seasonal, avian and pandemic influenza. Historical lessons from old pandemics help in recognizing their significant social, economical and political impact and guide the current preparedness for a future human pandemic. Currendy circulating strains, such as the avian influenza H5N1 strain constitute a danger to public health and have significant pandemic potential. Regarding clinical characteristics it appears that disease associated with a pandemic will have a high case fatality rate especially in vulnerable populations. Furthermore, the need for confirmatory diagnostic testing will likely diminish as a pandemic progresses. With regards to management stockpiling one antiviral agent will probably not be enough. No uniform scientific conclusion about the success of a prepandemic H5N1 vaccine has been reached yet. Complete pandemic plans that address subtle issues surrounding stockpiling antivirals and prepandemic vaccines as well as non-pharmaceutical measures need to be ready and to be tested in practice in order to identify problems with implementation and gaps in preparedness.

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Role of combination antiviral therapy in pandemic influenza and stockpiling implications

Cited by 18 publications

References 21 publications

Progress and shortcomings in European national strategic plans for pandemic influenza

Progress and shortcomings in European national strategic plans for pandemic influenza

Antiviral Agents for Influenza: Molecular Targets, Concerns of Resistance, and New Treatment Options

Human influenza pandemics: Myth and reality

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