Comparison of Hospitalization Incidence in Influenza Outpatients Treated With Baloxavir Marboxil or Neuraminidase Inhibitors: A Health Insurance Claims Database Study

Abstract

Background Baloxavir marboxil (baloxavir) is a single-dose, oral anti-influenza drug with a novel mechanism of action. We compared the incidence of hospitalization in patients treated with baloxavir versus neuraminidase inhibitors. Methods This was a retrospective observational cohort study using real-world patient data extracted from a Japanese health insurance claims database. The enrollment period was October 1, 2018 to April 17, 2019. On day 1, eligible patients (N = 339 007) received baloxavir, oseltamivir, zanamivir, or laninamivir. Baseline characteristics were standardized using the inverse probability of treatment weighting method. Primary end point was the incidence of hospitalization (days 2–14). Secondary end points included antibacterial use, secondary pneumonia, and additional anti-influenza drug use. Results Compared with the baloxavir group, the incidence of hospitalization was greater in the oseltamivir group (risk ratio [RR] and 95% confidence interval [CI], 1.41 [1.00–2.00]; risk difference [RD] and 95% CI, 0.06 [0.01–0.12]) and zanamivir group (RR, 1.85 [1.23–2.78]; RD, 0.11 [0.02–0.20]). Oseltamivir-treated patients were less likely to require antibacterials than baloxavir-treated patients (RR, 0.87 [0.82–0.91]). However, oseltamivir-treated patients were more likely to be hospitalized with antibacterials (RR, 1.70 [1.21–2.38]) or antibacterial injection (RR, 1.67 [1.17–2.38]) than baloxavir-treated patients (post hoc analysis). Compared with baloxavir-treated patients, additional anti-influenza drug use was greater in oseltamivir-, zanamivir-, and laninamivir-treated patients (RR, 1.51 [1.05–2.18], 2.84 [2.04–3.96], and 1.68 [1.35–2.10], respectively). Conclusions Baloxavir is an efficacious anti-influenza treatment that may reduce hospitalization compared with oseltamivir and zanamivir.

Antiviral therapies for influenza

“…Real-world data comparing baloxavir and three NAIs (oseltamivir, zanamivir, and laninamivir) suggested that baloxavir users had a lower incidence of hospitalization compared with oseltamivir and zanamivir users in the outpatient setting. NAI users had more need for additional anti-influenza drug use than baloxavir users [69 ▪ ]. A network meta-analysis confirmed the clinical efficacy of all four NAIs and baloxavir with a shortening of time to alleviate influenza symptoms (TTAS), with zanamivir associated with the shortest TTAS.…”

Factors Associated With the Development of Bacterial Pneumonia Related to Seasonal Influenza Virus Infection: A Study Using a Large-scale Health Insurance Claim Database

“…We included repetitive cases of influenza in 1 season as an independent variable in the multivariable analyses to assess whether repetitive influenza increases the risk of bacterial pneumonia. Furthermore, anti-influenza drugs have been reported to suppress SP development, depending on the type of drug used [ 25 ]. Therefore, the types of anti-influenza drugs were also included as possible confounding factors in the multivariable regression model for SP.…”

Influenza: clinical aspects, diagnosis, and treatment

“…Compared to placebo, baloxavir significantly improved time to improvement [23 ▪▪ ] and time to alleviation [21] of influenza symptoms; and faster viral clearance for adults compared with placebo or oseltamvir [21]. Observational data in Japan have shown decreased hospitalizations for patients treated with baloxavir vs oseltamivir [26]. Although neuraminidase inhibitors tend to be less efficacious for influenza B, baloxavir was observed to have superior clinical efficacy in time to improvement in influenza symptoms compared to both placebo and oseltamivir [23 ▪▪ ,27].…”