Table 4.
GRADE Evidence Profile for Oral Oseltamivir Versus Inhaled Zanamivir
| Outcome | Quality Assessment | Summary of Findings | |||||
|---|---|---|---|---|---|---|---|
| Patients (Studies), n* | Overall Quality of Evidence | Study Event Rates, n/N (%) | Relative Effect (95% CI) | Anticipated Absolute Effects | |||
| Zanamivir | Oseltamivir | Risk With Zanamivir | Absolute Effect With Oseltamivir (95% CI) | ||||
| Mortality | 489 (1) | Very low†‡§‖ | 0/13 (0) | 21/476 (4.4) | OR, 1.27 (0.07–22.16)¶ | 5 deaths per 1000 patients** | 1 more death (5 fewer to 95 more deaths) per 1000 patients |
| Hospitalization | 489 (1) | Very low†‡§‖ | 8/13 (61.5) | 329/476 (69.1) | OR, 1.4 (0.45–4.35) | 615 hospitalizations per 1000 patients | 76 more hospitalizations (197 fewer to 259 more hospitalizations) per 1000 patients |
| ICU admissions, mechanical ventilation, or respiratory failure | 489 (1) | Very low†‡‖ | 3/13 (23.1) | 71/476 (14.9) | OR, 0.58 (0.16–2.18) | 231 admissions per 1000 patients | 83 fewer admissions (185 fewer to 165 more admissions) per 1000 patients |
| Duration of signs and symptoms | 1932 (5) | Very low due to risk of bias†‖ | 760 | 1172 | - | - | Mean time was 0.26 SD higher (0.07 to 0.45 SD higher)†† |
| Complications | Not measured | ||||||
| Critical adverse events | 1045 (1) | Very low due to risk of bias†‖ | 402 | 643 | Rate ratio, 2.9 (0.37–23.05) | 7 adverse events per 1000 patient-years | 14 more adverse events (5 fewer to 165 more events) per 1000 patient-years |
| Viral shedding (persistent virus) | 46(1) | Very low due to imprecision and risk of bias§‖ | 4/23 (17.4) | 9/23 (39.1) | OR, 3.05 (0.78–11.96) | 174 cases of persistent virus per 1000 patients | 217 more cases of persistent virus (33 fewer to 542 more cases) per 1000 patients |
GRADE = Grading of Recommendations Assessment, Development, and Evaluation; ICU = intensive care unit; OR = odds ratio.
*
Follow-up to 30 d.
†
Not adjusted for potential confounding factors.
‡
Quality was downgraded because results were calculated from pregnant women and the effect may therefore not be applicable to typical patients.
§
Effect includes benefit and harm and few patients and events.
‖
Although we did not downgrade, publication bias cannot be excluded.
¶
No deaths were reported in 2 studies (0 of 84 with oseltamivir and 0 of 76 with zanamivir).
**
Based on calculations from event rate.
††
The standardized mean difference represents a small increase in effect.