Perspectives on antiviral use during pandemic influenza
Perspectives on antiviral use during pandemic influenza
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DOI：
10.1098/rstb.2001.1007
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发表时间：
2001-12-29
影响因子：
6.3
通讯作者：
Hayden, FG
中科院分区：
文献类型：
--
作者：
Hayden, FG
抗病毒药物可能在大流行性流感的初步应对中发挥重要作用，特别是在可能无法获得有效疫苗的情况下，通过降低发病率和死亡率。 M2 抑制剂对大流行性流感的化学预防部分有效，大流行性流感研究的证据表明神经氨酸酶抑制剂可有效预防。除了使用 M2 抑制剂治疗观察到的症状益处外，早期使用神经氨酸酶抑制剂已被证明可以降低下呼吸道并发症的风险。临床药理学和药物不良反应概况表明，考虑到个体用药和耐受性监测的需要，神经氨酸酶抑制剂和金刚乙胺优于金刚烷胺。耐药病毒的传播可能会极大地限制 M2 抑制剂的有效性，并且大流行毒株中存在对 M2 抑制剂产生主要耐药性的可能性。神经氨酸酶抑制剂出现耐药性的频率较低，并且数学模型研究表明，神经氨酸酶抑制剂抗性变体观察到的耐药病毒传播性降低将导致此类变体的社区传播可以忽略不计。因此，目前可用的抗病毒药物在疫苗问世之前对应对大流行性流感有很大希望，尽管在实现这一潜力方面仍有大量工作要做。通过储存、教育卫生保健提供者和公众等机制显着增加可用抗病毒药物的数量，以及制定向有需要的人快速分发的有效手段，对于制定有效的应对措施至关重要，但目前仍然存在未解决的问题。
Antiviral agents could potentially play a major role in the initial response to pandemic influenza, particularly with the likelihood that an effective vaccine is unavailable, by reducing morbidity and mortality. The M2 inhibitors are partially effective for chemoprophylaxis of pandemic influenza and evidence from studies of interpandemic influenza indicate that the neuraminidase inhibitors would be effective in prevention. In addition to the symptom benefit observed with M2 inhibitor treatment, early therapeutic use of neuraminidase inhibitors has been shown to reduce the risk of lower respiratory complications. Clinical pharmacology and adverse drug effect profiles indicate that the neuraminidase inhibitors and rimantadine are preferable to amantadine with regard to the need for individual proscribing and tolerance monitoring. Transmission of drug-resistant virus could substantially limit the effectiveness of M2 inhibitors and the possibility exists for primary M2 inhibitor resistance in a pandemic strain. The frequency of resistance emergence is lower with neuraminidase inhibitors and mathematical modelling studies indicate that the reduced transmissibility of drug-resistant virus observed with neuraminidase inhibitor-resistant variants would lead to negligible community spread of such variants. Thus, there are antiviral drugs currently available that hold considerable promise for response to pandemic influenza before a vaccine is available, although considerable work remains in realizing this potential. Markedly increasing the quantity of available antiviral agents through mechanisms such as stockpiling, educating health care providers and the public and developing effective means of rapid distribution to those in need are essential in developing an effective response, but remain currently unresolved problems.