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Examining cases of patients with influenza

Let’s explore some cases of patients who were chosen as appropriate candidates for Rapivab® (peramivir injection).

 

CASE STUDY:
intravenous (IV) administration

When patients are unable to swallow, IV administration of fluids and medications, including Rapivab, can help deliver the therapy and support they need.1

 

Presentation

38-year-old female

  • History of gastroesophageal reflux disease (GERD) and asthma

  • Presents with headache, muscle aches, cough, and fever, as well as heartburn2,3

  • Busy working professional; she expresses worry about catching the flu because she cannot afford to miss work

Evaluation

  • Patient denied tender nodes, sputum production, chest pain, and wheezing4-6

  • No flu vaccination

  • Lapsed esomeprazole prescription7

  • Vital signs: temperature: 102°F, heart rate (HR): 80 bpm, respiratory rate (RR): 18/min, blood pressure (BP): 88/58 mm Hg8-11

  • Examination was notable for high fever, cough, and dysphagia associated with heartburn8,12

Treatment

  • Patient was treated with 1 dose of Rapivab, a complete treatment course for acute, uncomplicated influenza13

  • IV administration was deemed preferable due to her7:

    • Inability to swallow an oral antiviral regimen

    • History of asthma

    • Established IV access from IV proton pump inhibitor and hydration therapy

  • Patient was also treated for her GERD exacerbation and then observed for the next 20 hours

Results

The patient was discharged once she exhibited stable vital signs, was able to ambulate, and oral intake was initiated. She was given instructions to call her outpatient physician should symptoms not resolve completely over the next few days.

 

CASE STUDY:
compliance with therapy

When noncompliance is a suspected issue, clinicians can turn to the assurance of a full course of antiviral influenza therapy with Rapivab when an entire infusion is received.

 

Presentation

68-year-old male

  • Smoker with chronic bronchitis who was well prior to “catching a virus”

  • Presents with a 12-hour history of fever, myalgia, sore throat, cough, and nausea

Evaluation

  • Patient denied any chest pain, dizziness, or shortness of breath

  • No flu vaccination

  • Admits noncompliance with previous antiviral therapy regimen

  • Chronic obstructive pulmonary disease (COPD) is controlled with medication; does not require supplementary oxygen

  • Examination was notable for high fever and muscle aches

  • Chest x-ray was consistent with chronic COPD but showed no evidence of pneumonia

Treatment

  • Patient was treated with 1 dose of Rapivab, a complete treatment course for acute, uncomplicated influenza

  • Treatment with Rapivab was deemed preferable due to the patient’s nausea and previous inability to comply with a multiday, oral antiviral regimen

Results

Patient was then observed for the next 10 hours and began to feel better, with diminished fever and improvement in fatigue. His vital signs were stable, oral intake was initiated, and he was able to ambulate. He was discharged from the emergency department (ED) with instructions to call his outpatient physician should symptoms not resolve completely over the next few days.

References: 1. Dychter SS, Gold DA, Carson D, Haller W. Intravenous therapy: a review of complications and economic considerations of peripheral access. J Infus Nurs. 2012;35(2):84-91. 2. Flu symptoms & complications. Centers for Disease Control and Prevention website. http://www.cdc.gov/flu/about/disease/complications.htm. Updated May 23, 2016. Accessed December 16, 2016. 3. Symptoms & causes of GER & GERD. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/symptoms-causes Updated November 2014. Accessed February 3, 2017. 4. Tarasidis GS, Wilson KF. Diagnosis of asthma: clinical assessment. Int Forum Allergy Rhinol. 2015;5(suppl 1):S23-S26. 5. Wunderink RG, Waterer GW. Clinical practice. Community-acquired pneumonia. N Engl J Med. 2014;370(6):543-551. 6. Shulman ST, Bisno AL, Clegg HW, et al; Infectious Disease Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. 7. Nexium [package insert]. Wilmington, DE: AstraZeneca; 2014. 8. Cohen YZ, Dolin R. Influenza. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill; 2015. http://accessmedicine.mhmedical.com/content.aspx?sectionid=79738663&bookid=1130&jumpsectionID=79738694&Resultclick= 2&q=influenza+pathogenesis. Accessed October 17, 2016. 9. What is hypotension? National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/hyp. Updated November 1, 2010. Accessed December 16, 2016. 10. Low blood pressure - when blood pressure is too low. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Low-Blood-Pressure_UCM_301785_Article.jsp#.WDyu9LIrLct. Updated October 2016. Accessed December 16, 2016. 11. Charbek E. Normal vital signs. Medscape website.http://emedicine.medscape.com/article/2172054-overview. Updated August 27, 2015. Accessed February 1, 2017. 12. Cho SY, Choung RS, Saito YA, et al. Prevalence and risk factors for dysphagia: a USA community study. Neurogastroenterol Motil. 2015;27(2):212-219. 13. Rapivab [package insert]. Summit, NJ: Seqirus USA Inc; 2017.
Important Safety Information  

Important Safety Information

Rapivab® (peramivir injection) is indicated for the treatment of acute uncomplicated influenza in patients 18 years and older who have been symptomatic for no more than 2 days.

Efficacy of Rapivab was based on clinical trials in which the predominant influenza virus type was influenza A; a limited number of subjects infected with influenza B virus were enrolled.

Influenza viruses change over time. Emergence of resistance substitutions could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefit of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use Rapivab.

Efficacy could not be established in patients with serious influenza requiring hospitalization.

Contraindications

Rapivab is contraindicated in patients with known serious hypersensitivity or anaphylaxis to peramivir or any component of the product. Severe allergic reactions have included anaphylaxis, erythema multiforme, and Stevens-Johnson syndrome.

Warnings and Precautions
  • Rare cases of serious skin reactions, including erythema multiforme, have been reported with Rapivab in clinical studies and in postmarketing experience. Cases of anaphylaxis and Stevens-Johnson syndrome have been reported in postmarketing experience with Rapivab. Discontinue Rapivab and institute appropriate treatment if anaphylaxis or a serious skin reaction occurs or is suspected. The use of Rapivab is contraindicated in patients with known serious hypersensitivity or anaphylaxis to Rapivab.

  • Patients with influenza may be at an increased risk of hallucinations, delirium, and abnormal behavior early in their illness. There have been postmarketing reports (from Japan) of delirium and abnormal behavior leading to injury in patients with influenza who were receiving neuraminidase inhibitors, including Rapivab. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made, but they appear to be uncommon. These events were reported primarily among pediatric patients. The contribution of Rapivab to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior.

  • Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza. Rapivab has not been shown to prevent such complications.

Adverse Reactions

The most common adverse reaction was diarrhea (8% Rapivab vs 7% placebo).

Lab abnormalities (incidence ≥2%) occurring more commonly with Rapivab than placebo were elevated ALT 2.5 times the upper limit of normal (3% vs 2%), elevated serum glucose >160 mg/dL (5% vs 3%), elevated CPK at least 6 times the upper limit of normal (4% vs 2%) and neutrophils <1.0 x 109/L (8% vs 6%).

Concurrent Use With Live Attenuated Influenza Vaccine

Antiviral drugs may inhibit viral replication of a live attenuated influenza vaccine (LAIV). The concurrent use of Rapivab with LAIV intranasal has not been evaluated. Because of the potential for interference between these two products, avoid use of Rapivab within 2 weeks after or 48 hours before administration of LAIV unless medically indicated.

Please see full prescribing information for Rapivab.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/Safety/MedWatch/ or call 1-800-FDA-1088.