Oseltamivir Reduces Risk of Serious Neuropsychiatric Events in Children During Influenza Episodes
Oseltamivir treatment was associated with a reduction in serious neuropsychiatric events in children and adolescents during influenza episodes, according to cohort study results published in JAMA Neurology.
“During influenza exposure periods, treatment with oseltamivir was associated with an approximately 50% reduction in the risk of serious neuropsychiatric events compared to influenza periods without oseltamivir,” wrote James W. Antoon, MD, PhD, MPH, Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, and study coauthors.
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The retrospective cohort included 692,295 individuals aged 5 to 17 years who were enrolled in Tennessee Medicaid. Researchers assessed the frequency of neuropsychiatric events requiring hospitalization over 4 influenza seasons. Each follow-up period began on the first day of influenza season and continued through the earliest occurrence of either an outcome event, reaching age 18, loss of enrollment, death, or the end of the study or season.
Every person-day of follow-up was assigned to 1 of 5 groups: untreated influenza (up to 10 days after diagnosis), treated influenza (days in which oseltamivir was dispensed within the 10-day influenza period), posttreatment period (days between the completion of oseltamivir and the end of the 10-day influenza period), influenza prophylaxis (oseltamivir administered without influenza), and no exposure (no exposure to influenza or oseltamivir). The authors then estimated adjusted incidence rate ratios (aIRRs) with 95% confidence intervals to account for participants contributing to several exposure groups.
During 19,688,320 person-weeks of follow-up, a total of 1230 serious neuropsychiatric events (898 neurologic, 332 psychiatric) occurred. The overall incidence of serious neuropsychiatric events was 6.25 (95% CI, 5.90-6.61) per 100,000 person-weeks, and the risk of a serious event occurring was lowest during periods without influenza exposure.
In those treated with oseltamivir, the risk of a serious neuropsychiatric event during the influenza and posttreatment periods was lower compared to untreated participants (treated influenza: aIRR, 0.53; 95% CI, 0.33-0.88; posttreatment period: aIRR, 0.42; 95% CI, 0.24-0.76). Seizures were the most common event during influenza periods, followed by mood disorders and suicidal or self-harm behaviors.
“These results support the dual assertions that influenza infection, independent of other measured factors, increases the risk of serious neuropsychiatric events and that treatment with oseltamivir may protect against these influenza-related complications,” the researchers wrote. “Findings from this study should inform both caregivers and clinicians on the safety of oseltamivir and its role in preventing influenza-associated complications,” they concluded.
