Does C-reactive protein predict time to recovery and benefit from oseltamivir treatment in primary care patients with influenza-like illness?: A randomized controlled trial secondary analysis
Harbin, Nicolay Jonassen; Rystedt, Karin; Lindbaek, Morten; Radzeviciene, Ruta; Westin, Johan; Gunnarsson, Ronny; Butler, Christopher C; van der Velden, Alike W; Verheij, Theo J; Sundvall, Pär-Daniel
(2021) Scandinavian Journal of Primary Health Care, volume 39, issue 4, pp. 527 - 532
(Article)
Abstract
OBJECTIVE: Recovery time and treatment effect of oseltamivir in influenza-like illness (ILI) differs between patient groups. A point-of-care test to better predict ILI duration and identify patients who are most likely to benefit from oseltamivir treatment would aid prescribing decisions in primary care. This study aimed to investigate whether a
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C-reactive protein (CRP) concentration of ≥30 mg/L can predict (1) ILI disease duration, and (2) which patients are most likely to benefit from oseltamivir treatment. DESIGN: Secondary analysis of randomized controlled trial data. SETTING: Primary care in Lithuania, Sweden and Norway during three consecutive influenza seasons 2016-2018. SUBJECTS: A total of 277 ILI patients aged one year or older and symptom duration of ≤72 h. MAIN OUTCOME MEASURES: Capillary blood CRP concentration at baseline, and ILI recovery time defined as having 'returned to usual daily activity' with residual symptoms minimally interfering. RESULTS: At baseline, 20% (55/277) had CRP concentrations ≥30mg/L (range 0-210). CRP concentration ≥30 mg/L was not associated with recovery time (adjusted hazards ratio (HR) 0.80: 95% CI 0.50-1.3; p = 0.33). Interaction analysis of CRP concentration ≥30 mg/L and oseltamivir treatment did not identify which patients benefit more from oseltamivir treatment (adjusted HR 0.69: 95% CI 0.37-1.3; p = 0.23). CONCLUSION: There was no association between CRP concentration of ≥30 mg/L and recovery time from ILI. Furthermore, CRP could not predict which ILI patients benefit more from oseltamivir treatment. Hence, we do not recommend CRP testing for predicting ILI recovery time or identifying patients who will receive particular benefit from oseltamivir treatment.Key PointsPredicting disease course of influenza-like illness (ILI), and identifying which patients benefit from oseltamivir treatment is a challenge for physicians.• There was no association between CRP concentration at baseline and recovery time in patients consulting with ILI in primary care.• There was no association between CRP concentration at baseline and benefit from oseltamivir treatment.• We, therefore, do not recommend CRP testing for predicting recovery time or in decision-making concerning oseltamivir prescribing in ILI patients.
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Keywords: antiviral treatment, C-reactive protein, influenza-like illness, primary health care, recovery time, respiratory tract infections, Public Health, Environmental and Occupational Health, Journal Article
ISSN: 0281-3432
Publisher: Informa Healthcare
Note: Funding Information: AWV reports personal educational fees from Reckitt Benckiser, all outside the submitted work. TV reports grants from the NIHR, Netherlands Organization of Health Research and Development, and the EU Innovative Medicines Initiative, which has Janssen Pharmaceuticals, Biocartis, Janssen, BioMerieux, and Berry Consultants as partners, all outside the submitted work. CCB reports grants from National Institute for Health Research (NIHR) Health as NIHR Senior Investigator, grants from the NIHR Health Technology Assessment Programme to support the study, grants from NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance, grants from NIHR Health for the MedTech and In Vitro Diagnostics Cooperative for innovative diagnostics and monitoring technology to enhance Community Healthcare during the conduct of the study, personal fees from Pfizer and Roche Molecular Systems, grants from Roche Molecular Diagnostics, all outside the submitted work. All other authors declare no competing interests. Funding Information: The ALIC4E study was supported by the European Commission FP7 Programme. The Healthcare Committee, Region V?stra G?taland, Sweden, partially funded the Swedish part of the study. The Antibiotic Centre for primary Care, University of Oslo partially funded the Norwegian part of the study. The authors thank the participating primary care clinicians and the patients who participated in this study. Publisher Copyright: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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