Guidance over anti-flu drug 'wrong'

Guidance produced in November says certain patients can have Relenza

An influential medical journal has hit out at the decision to prescribe an anti-flu drug.

The Drug and Therapeutics Bulletin (DTB) has said it is opposed to guidance from the National Institute for Clinical Excellence (NICE) over Relenza.

NICE now recommends that Relenza, under specific circumstances, should be prescribed for patients "at risk".

But the DTB is calling on doctors to make up their own minds about the drug.

At-risk groups would include the over 65s or those with certain underlying medical problems.

We would encourage doctors and other health care professionals to look at the material reviewed by NICE and DTB on Relenza and draw their own conclusions

Professor Joe Collier, DTB editor

But the DTB, which is published by the Consumers Association and provides independent advice, says this guidance goes against original statements given by both themselves and NICE after independent reviews into the drug.

Effectiveness

The DTB claims the effectiveness of Relenza has not been proved and that the advice from NICE is based primarily on a detailed examination of pooled information from trials of Relenza in at-risk patients.

But the DTB says that only one of the trials was conducted with such patients.

It adds that the suggestion that Relenza can shorten the duration of symptoms in at-risk patients is not a good enough reason to prescribe the drug.

Professor Joe Collier, DTBEditor of Drug and Therapeutics Bulletin, said they do not believe Relenza should be prescribed by doctors.

"Despite the guidance given by the National Institute for Clinical Excellence and having looked at their published data, we believe that, on current evidence, Relenza should not be prescribed by doctors in the NHS for treating patients with flu.

Standing by guidelines

"This includes those at particular risk of developing complications of the infection," he said.

Professor Collier said he would be "interested" to learn how the two sides could differ so greatly and that he had called for talks with NICE.

"We would encourage doctors and other health care professionals to look at the material reviewed by NICE and DTB on Relenza and draw their own conclusions," he added.

A spokesperson for NICE said they were happy for Relenza (zanamivir) to be used for at risk groups and that they will be standing by their guidelines.

"The institute is satisfied that its guidance on zanamivir is robust and is in the best interests of patients who rely on the NHS for their care.

"The institute's processes for accessing and interpreting evidence are rigorous and its arrangements for consulting on its conclusions are comprehensive," said the spokesperson.

NICE said it regularly reviews its guidance and it would be looking at Relenza again in 2002.

In the United States Relenza carries specific warnings that it should not be given to certain classes of patients with respiratory diseases and it has been implicated in a number of deaths in the US.

But critics say this is a tiny number in comparison to the doses given out.