JAMA
Vol. 303 No. 9, pp. 813-902, March 3, 2010
http://jama.ama-assn.org/current.dtl

Losing the Opportunity to Study Influenza Drugs
Andrea Meyerhoff; Paul Lietman

[First 150 words per JAMA convention]
Shortly after 2009 influenza A(H1N1) emerged, we advocated for real-time clinical trials to make use of the rare opportunity—and an ethical imperative—to study influenza drugs while the pandemic is ongoing.1 Tran et al2 further emphasized this need for prospective clinical trials during the outbreak. Persistent gaps in knowledge about drugs to treat influenza and the recent decision by the US Food and Drug Administration (FDA) to issue an Emergency Use Authorization for peramivir,3 an unapproved drug, make this need even more acute.

The efficacy of oseltamivir and zanamivir, the main drugs available to treat influenza A(H1N1) in the United States, was based on findings that these drugs shorten the duration of flu symptoms by 1.3 and 1.5 days, respectively. However, a recent meta-analysis of 12 clinical trials of oseltamivir suggested that this drug did not reduce the rate of pneumonia in . . .