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Oseltamivir Compared With the Chinese Traditional Therapy Maxingshigan–Yinqiaosan in the Treatment of H1N1 Influenza

A Randomized Trial

Chen Wang, MD, PhD;
Bin Cao, MD;
Qing-Quan Liu, MD;
Zhi-Qiang Zou, MD;
Zong-An Liang, MD;
Li Gu, MD;
Jian-Ping Dong, MD;
Li-Rong Liang, MD;
Xing-Wang Li, MD;
Ke Hu, MD;
Xue-Song He, MD;
Yan-Hua Sun, MD;
Yu An, MD;
Ting Yang, MD;
Zhi-Xin Cao, MD;
Yan-Mei Guo, MD;
Xian-Min Wen, MD;
Yu-Guang Wang, MD;
Ya-Ling Liu, MD; and
Liang-Duo Jiang, MD

+Author Affiliations

From Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, and Beijing Hospital, Ministry of Health, Beijing; Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing; Yantai Infectious Disease Hospital, Shandong; Chengdu Infectious Disease Hospital, Sichuan; Beijing Haidian Hospital, Beijing; Beijing Ditan Hospital, Institute of Infectious Diseases, Capital Medical University, Beijing; Renmin Hospital of Wuhan University; Changxindian Hospital of Fengtai District of Beijing, Beijing; Second Hospital of Chaoyang District of Beijing, Beijing; Second Hospital of Beijing, Beijing; and West China Medical School, West China Hospital, Sichuan University, Sichuan, China.

Abstract

Background: Observational studies from Asia suggest that maxingshigan–yinqiaosan may be effective in the treatment of acute H1N1 influenza.

Objective: To compare the efficacy and safety of oseltamivir and maxingshigan–yinqiaosan in treating uncomplicated H1N1 influenza.

Design: Prospective, nonblinded, randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00935194)

Setting: Eleven hospitals from 4 provinces in China.

Patients: 410 young adults aged 15 to 59 years with laboratory-confirmed H1N1 influenza.

Intervention: Oseltamivir, 75 mg twice daily; maxingshigan–yinqiaosan decoction (composed of 12 Chinese herbal medicines, including honey-fried Herba Ephedrae), 200 mL 4 times daily; oseltamivir plus maxingshigan–yinqiaosan; or no intervention (control). Interventions and control were given for 5 days.

Measurements: Primary outcome was time to fever resolution. Secondary outcomes included symptom scores and viral shedding determined by using real-time reverse transcriptase polymerase chain reaction.

Results: Significant reductions in the estimated median time to fever resolution compared with the control group (26.0 hours [95% CI, 24.0 to 33.0 hours]) were seen with oseltamivir (34% [95% CI, 20% to 46%]; P < 0.001), maxingshigan–yinqiaosan (37% [CI, 23% to 49%]; P < 0.001), and oseltamivir plus maxingshigan–yinqiaosan (47% [CI, 35% to 56%]; P < 0.001). Time to fever resolution was reduced by 19% (CI, 0.3% to 34%; P = 0.05) with oseltamivir plus maxingshigan–yinqiaosan compared with oseltamivir. The interventions and control did not differ in terms of decrease in symptom scores (P = 0.38). Two patients who received maxingshigan–yinqiaosan reported nausea and vomiting.

Limitations: Participants were young and had mild H1N1 influenza virus infection. Missing viral data precluded definitive conclusions about viral shedding.

Conclusion: Oseltamivir and maxingshigan–yinqiaosan, alone and in combination, reduced time to fever resolution in patients with H1N1 influenza virus infection. These data suggest that maxingshigan–yinqiaosan may be used as an alternative treatment of H1N1 influenza virus infection.

Primary Funding Source: Beijing Science and Technology Project and Beijing Nova Program.

http://www.annals.org/content/155/4/217.abstract