Characteristics and mortality of severe influenza cases treated with parenteral aqueous zanamivir, United Kingdom, October 2009 to January 2011

Abstract

Background: Aqueous zanamivir solution, an investigational product, was provided by the manufacturer on compassionate grounds for parenteral administration to severe H1N1pdm09 influenza cases during the 2009 pandemic. Objective: To describe characteristics and outcomes of UK patients receiving parenteral zanamivir therapy. Methods: Collaborators at multiple hospital sites gathered retrospective data on patients receiving aqueous zanamivir therapy between Q4 2009 and Q1 2011. We present analysis of the demographics, clinical features, treatment and outcomes of this cohort. Results: Data on 185 cases were obtained (response rate of 38%; median age 43 years; 62% male; 17% non-Caucasian ethnic group). Most frequent co-morbidities included cancer, immunosuppression and respiratory conditions. Most patients received intravenous zanamivir alone (90%), for durations of up to 21 days. 13% of cases had adverse effects related to zanamivir therapy. Thirty four percentage of cases died. No significant relationship was seen between mortality and timing or route of administration of aqueous zanamivir therapy. Conclusions: The response rate of this observational study of the outcomes of treatment of severe influenza was low, allowing limited conclusions to be drawn. Some potential adverse effects were noted. Clinicians should carefully consider potential risks and benefits of use of this product. New treatment options are urgently required to improve outcomes for patients with severe influenza infections.