Intended for healthcare professionals


WHO downgrades oseltamivir on drugs list after reviewing evidence

BMJ 2017; 357 doi: (Published 12 June 2017) Cite this as: BMJ 2017;357:j2841
  1. Zosia Kmietowicz
  1. The BMJ

Oseltamivir (Tamiflu) has been downgraded in the World Health Organization’s list of essential medicines from a “core” drug to one that is “complementary”—a category encompassing drugs that are deemed less cost effective.

Fiona Godlee, The BMJ’s editor in chief, welcomed the move as a victory for the journal’s campaign for evidence based medicine. “WHO’s decision is a vote for evidence based policy making, which will save money and harm. It is also an important milestone in the continuing fight for access to clinical trial data and independent research,” she said.

The expert committee that updates the WHO list every two years said that, since oseltamivir was added to the list in 2009, “there now exists additional evidence of oseltamivir in seasonal and pandemic flu which has reduced the previously estimated magnitude of effect of oseltamivir on relevant clinical outcomes.”1

Some of that new evidence comes from an analysis conducted by Cochrane reviewers and published in The BMJ in 2014 after the journal’s four and a half year campaign for Roche to release clinical studies on oseltamivir.2

The review found that oseltamivir shortened the duration of symptoms in adults by about a day but that it did not reduce the number of people admitted to hospital or complications of flu.3

The WHO committee said that the use of oseltamivir should be “restricted to severe illness due to confirmed or suspected influenza virus infection in critically ill hospitalised patients.” It said that WHO would update its guidelines on managing pandemic and seasonal flu in 2017 and that, “unless new information supporting the use in seasonal and pandemic outbreaks is provided, the next Expert Committee might consider oseltamivir for deletion.”

The UK government spent £560m (€635m; $712m) on antivirals from 2006-07 to 2012-13; £424m on oseltamivir and £136m on zanamivir (Relenza)4; and a further £49m in 2014 to replace stocks of oseltamivir that were due to expire.5

Margaret Hodge, who was chair of the House of Commons Public Accounts Committee when the £560m figure was published, described as “extremely worrying” the decision to purchase oseltamivir at such a great cost “despite there being question marks over the effectiveness of the drug.”6


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