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29 Apr 2014

The Federal Government has committed to maintain its expensive stockpile of the antiviral drugs Tamiflu and Relenza in the face of evidence challenging their effectiveness.

A Cochrane evidence review conducted by The Cochrane Collaboration and the British Medical Journal found that the antivirals oseltamivir (marketed as Tamiflu) and zanamivir (sold as Relenza) provided limited benefit and, in the case of the former, increased the risk that patients would experience vomiting, nausea and psychiatric and kidney problems.

Antivirals were added to the country’s $192 million National Medical Stockpile in 2004, and substantial quantities of Tamiflu and Relenza have been maintained for use in the event of large influenza outbreaks.

But the Cochrane review found that the drugs only shortened the experience of flu-like symptoms by about half a day, and that there was no reliable evidence that either reduced the risk of those infected with the flu being admitted to hospital or developing serious complications such as pneumonia, bronchitis, sinusitis or ear infection.

The use of the drugs as a preventive measure was also found to be very limited or non-existent. They only slightly reduced to risk of developing flu symptoms, and there was no evidence they could stop people acting as carriers and spreading the disease.

In addition, the review found Tamiflu was associated with a 4 per cent higher risk of nausea and vomiting in adults, as well as mood changes among 1 per cent of uninfected people given the drug as a preventive measure.

Bond University public health expert Professor Chris Del Mar, a co-author of the study, told Six Minutes the findings called into question the value of spending millions of dollars accumulating and maintaining stockpiles of the drugs.

“As an investment for dealing in pandemics, it’s probably not such a cost-effective option,” Professor Del Mar said, and instead highlighted the need for increased effort to rehearse public health control measures such as quarantining, washing hands, and the regular use of gowns, gloves and masks.

The review was conducted using previously unpublished data, and BMJ Editor in Chief Dr Fiona Godlee told the ABC governments around the world had committed millions of dollars to stockpile the drugs based on incomplete information.

Dr Godlee said the authors had found it particularly difficult to get information about Tamiflu from its manufacturer Roche, describing the process as a “really lengthy cat and mouse, Alice in Wonderland, bizarre experience of trying to get data on a drug which governments around the world were busy buying, stockpiling and spending billions of dollars on”.

But the Health Department, while acknowledging the results of the Cochrane review, said that at this stage it had no plans to change its strategy of stockpiling drugs.

“Based on all available data, including the most recent Cochrane report, about these drugs, the Australian Government will continue to maintain its stockpile of the antiviral drugs Tamiflu and Relenza as a complement to influenza vaccination and other pandemic control measures,” a Department spokeswoman said.

“During a pandemic, antivirals can be used as part of a suite of potential health protection measures designed to reduce the impact of a pandemic, vaccines, application of infection control, social distancing measures and nationally-coordinated information and messaging,” the spokeswoman said.

The Department said its position was consistent with recommendations from the US Centers for Disease Control and Prevention regarding the use of neuraminidase inhibitor drugs, and that it regularly consulted with experts including the World Health Organisation regarding its medicines stockpile.

It said the quantities of Tamiflu and Relenza in the stockpile were comparable with that held by other nations, and were “consistent with expert mathematical modelling on appropriate reserves for Australia”.

Roche said it fundamentally disagreed with the findings of the Cochrane review.

In a statement, the company said: “We firmly stand by the quality and integrity of our data, reflected in decisions reached by 100 regulators across the world and subsequent real-world evidence, demonstrating that Tamiflu is an effective medicine in the treatment and prevention of influenza”.

Adrian Rollins

Published: 29 Apr 2014