What we know about treating seasonal influenza

Each year, seasonal influenza causes increased morbidity, decreased work productivity, increased work load on doctors, associated healthcare costs and in some cases, hospitalisation and even mortality. Currently, most European primary care services promote self-care for patients with influenza-like illness (ILI), while in USA and Japan, antiviral treatment with neuraminidase inhibitors is common.

What we are not sure about

When reflecting on the H1N1 pandemic, primary care clinicians and public health physicians often ask whether the liberal use of oseltamivir was justified and whether diagnosis based on symptoms, as opposed to point-of-care testing to guide treatment, is the most cost-effective strategy. While there is some evidence from trials sponsored by pharmaceutical companies of the effectiveness of neuraminidase inhibitors in reducing the illness duration of patients infected with influenza and perhaps in decreasing complications, the evidence is not convincing and a number of questions still remain.

What this trial is exploring

The primary objective of the ALIC4E trial is to determine whether adding antiviral treatment to best usual primary care is effective in reducing time to return to usual daily activity. It is also investigating the clinical cost and effectiveness of the addition of antivirals to usual care initially oseltamivir. The study is also looking at sub-groups and how they respond to different treatments allowing analysis throughout the trial. A qualitative research component will review barriers to recruitment in infectious disease research.

Study design and recruitment

ALICE4E is a large-scale, international, publically-funded pragmatic, unblinded, individually-randomised controlled trial, being conducted in primary care in 16 European countries simultaneously, including in Ireland. Recruitment is taking place at general practices in each country during the officially-declared flu season, over three years, with a target recruitment of over 4,000 patients. In Ireland five general practices are involved in recruitment.

A major milestone was reached during the third week of January 2018 when the 2000th patient was recruited into the trial.

What does participation involve?

Patients presenting with flu-like symptoms at the practices involved in the trial who agree to participate in this study are randomised to either intervention or control group. The control group receive best usual primary care and antiviral treatment is added to best usual primary care in the intervention group. Participants then complete a patient diary for 14 days, recording their return to normal activity levels.

For more information

The trial is sponsored by the University of Oxford and is funded by the European Union. The ALIC4E  trial is being delivered as  work package of the Platform for European Preparedness Against (Re-) emerging Epidemics (PREPARE) consortium grant. PREPARE is a European Commission funded network for the rapid and efficient delivery of harmonised, large-scale clinical research studies on infectious diseases. The Health Research Board, Primary Care Clinical Trials Network Ireland is coordinating the Irish component of the trial during season 3.