Financial Conflicts Tied to Influenza Drug Review Results

Larry Hand

October 07, 2014

Systematic review authors with financial conflicts of interest are more likely to report favorably about the effects of neuraminidase inhibitors on the prevention and treatment of influenza than authors with no financial conflicts, according to an article published in the October 7 issue of the Annals of Internal Medicine.

Adam G. Dunn, PhD, from the Centre for Health Informatics, University of New South Wales, Sydney, Australia, and colleagues analyzed 26 systematic reviews of neuraminidase inhibitors, 13 of which dealt with prevention and 24 of which dealt with treatment of influenza, providing a total of 37 distinct assessments.

Although previous studies have pointed to author financial conflicts of interest influencing the "production and synthesis of scientific evidence," this is the first study to apply specifically to neuraminidase inhibitors, Dr Dunn and colleagues write.

"Reviews of neuraminidase inhibitors exhibit wide variation in their conclusions, ranging from strong endorsements of the use of these agents in the prophylaxis and treatment of influenza to more conservative assessments questioning the evidence on the drugs' safety and efficacy," they write.

In this study, two researchers assessed redacted versions of the systematic reviews. The versions did not contain authors' names, affiliations, or financial conflict information. They also did not have the journal name, formatting, acknowledgments, or references.

The two researchers evaluated and classified assessments as favorable or not favorable, agreeing 86% of the time, with disagreement resolved by a third researcher.

Of the 26 systematic reviews, 7 were Cochrane reviews, 19 included a meta-analysis, all were about randomized controlled trials, and 5 included evidence from clinical study reports or patient-level data. Patient populations included adults, children, and hospitalized patients.

Of the 26 systematic reviews, 7 (26%) reviews and 8 (22%) of the 37 assessments were associated with a financial conflict. Of the 37 assessments, the researchers graded 12 (32%) as favorable. Seven (88%) of eight assessments associated with a financial conflict of interest turned out to be favorable compared with five (17%) of 29 assessments not associated with financial conflicts.

When reviews assessed both prevention and treatment separately, the reviews associated with financial conflicts were more likely to be graded favorable for both.

None of the authors with conflicts in this analysis was an author of Cochrane review.

"Reviewers with such conflicts were also less likely to address issues with the underlying primary clinical evidence, such as publication bias and the lack of access to comprehensive study data," the researchers write.

They add that conflicting assessments have downstream effects, including, "If the benefits of neuraminidase inhibitors are eventually found to have been inflated, millions of patients will have been unnecessarily exposed to drugs that may be of little or no benefit."

They conclude, "The reporting of financial conflicts of interest in systematic reviews may not be sufficient to mitigate the effects of industry affiliations, and further measures may be necessary to ensure that industry collaborations do not compromise the scientific evidence."

This research was funded primarily by the Australian National Health and Medical Research Council. Dr Dunn has reported receiving grant funding from the National Health and Medical Research Council. The other authors have disclosed no relevant financial relationships.

Ann Intern Med. 2014;161:513-518. Abstract

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