The Pharmaceutical Journal
Vol 270 No 7238 p291
1 March 2003

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National Institute for Clinical Excellence (www.nice.org.uk)

NICE says "no" to amantadine for influenza treatment

The National Institute for Clinical Excellence has recommended that amantadine (Lysovir) should not be used for the treatment of influenza.

In new guidance issued this week, the institute also recommends that neither zanamivir (Relenza) nor oseltamivir (Tamiflu) should be used to treat a 'flu-like illness in people who are otherwise healthy (ie, unlikely to be at risk of developing complications).

The guidance supercedes recommendations made by NICE on the use of zanamivir in November 2000 (PJ, 25 November 2000, p777) and introduces guidance for amantadine and oseltamivir.

It states that when the number of people with 'flu reaches a high-enough level in the community, zanamivir or oseltamivir are recommended to treat 'flu-like illness in those considered to be at risk of developing complications, provided that they start treatment within 48 hours of the onset of symptoms.

People considered to be at risk include those aged 65 years or over, those with chronic lung disease, heart disease, long-term kidney disease, or diabetes and those with a compromised immune system.

At-risk patients over 12 years can be treated with either agent but oseltamivir is recommended to treat 'flu-like illness in children (aged over one year).

NICE says that it considered several points when developing its recommendations. These include the low probability that people with 'flu-like illness actually have 'flu when the viruses are not circulating in the community. The institute also noted that the rate of GP consultations would increase if a 'flu drug was thought to be readily prescribable.

The cost of using zanamivir and oseltamivir in any year will depend on the severity of the outbreak, NICE says, and is estimated at between £2m and £15m. The drugs become increasingly cost effective as the severity of an outbreak rises, particularly in winter when there is pressure on use of hospital beds.

NICE emphasises that it considers vaccination the most effective way of preventing illness from 'flu and that the drugs for 'flu treatment should not be used instead of immunisation. It calls for 'flu monitoring schemes to be used to spot the start of an outbreak as quickly as possible.

The manufacturer of Lysovir, Alliance, expressed disappointment at the recommendations made by NICE, stating that much of its data, extending to over 36,000 patients, related to otherwise healthy patients, and had thus been discounted by NICE's "rigid methodology".

NICE says that, following appeals against draft guidance, it is reconsidering evidence on the use of the antivirals in 'flu prophylaxis. It expects to issue these recommendations in June, this year.

Insulin pump therapy Insulin pump therapy is recommended as one option for people with type 1 diabetes, says NICE in guidance issued this week. It says pump therapy can be considered when multiple dose insulin has failed to manage a patient's diabetes provided the patient is willing and able to use such therapy. NICE adds that people beginning insulin pump therapy should be provided with training and ongoing support. Insulin pump therapy is not recommended for people with type 2 diabetes.

NICE has also issued guidance on the use of tension free vaginal tape for stress incontinence.

NICE guidance can be accessed via the internet (www.nice.org.uk).