Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: a meta-analysis of randomized controlled trials

Tejo, Alexandre Mestre; Peña-López, Yolanda; Forero, Carlos G.; Corbella, Xavier; Rello, Jordi

doi:10.1080/17512433.2021.1917378

Cited by 17 publications

(6 citation statements)

References 38 publications

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“…Previous studies have suggested that influenza patients aged <18 years who were treated with baloxavir had a shorter fever duration than those treated with oseltamivir [ 14 , 15 , 17 , 18 ]. Fever resolution was selected as an index of clinical effectiveness.…”

Section: Methodsmentioning

confidence: 99%

“…In 2018, baloxavir was approved for the oral treatment of influenza in Japan [ 9 ] and is widely used in clinical practice. Post-marketing surveillance in Japan and other clinical studies, including randomized control trials and meta-analyses, have shown the efficacy and safety of baloxavir in adult and pediatric influenza [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. For example, in a phase 3 clinical trial conducted during the 2016–2017 influenza season in adults and adolescents (CAPSTONE-1), baloxavir was superior to placebo in improving influenza symptoms and was superior to both oseltamivir and placebo in reducing the viral load in patients aged 12–64 years with uncomplicated influenza without severe side-effects [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Early Fever Resolution in Early Childhood Influenza Treated with Baloxavir Marboxil: A Retrospective Study Compared to Those with Oseltamivir

Nezu,

Hayashida,

Nagano

et al. 2023

Medicina

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Background and Objectives: Baloxavir marboxil is a novel cap-dependent endonuclease inhibitor prescribed for influenza treatment. Unlike neuraminidase inhibitors like oseltamivir, which impair viral release from infected host cells, baloxavir blocks influenza virus proliferation by inhibiting viral mRNA transcription. This study aimed to compare the effectiveness of baloxavir and oseltamivir for the treatment of early childhood influenza. Materials and Methods: Of 1410 patients diagnosed with influenza between 2015 and 2018 at a Japanese primary care outpatient clinic, 1111 pediatric patients aged 0–6 years who were treated with baloxavir (n = 555) or oseltamivir (n = 556) were enrolled retrospectively. The following clinical factors were compared between patients treated with baloxavir and oseltamivir: age, sex, time from fever onset to drug administration (<24 h or 24–48 h), time from drug administration to fever reduction, influenza type (A or B), and influenza vaccination before disease onset. The duration of the fever, which was used as an index of clinical effectiveness, was compared using the log-rank test. Clinical factors associated with fever duration were determined using multivariate logistic regression analysis. Results: Median age (3.0 vs. 2.5 years), influenza type A (99% vs. 47%), median duration from drug administration to fever resolution (1 day vs. 2 days), and influenza vaccination (done, 41% vs. not done, 65%) were significantly different between the baloxavir and oseltamivir groups (p < 0.001). The number of patients with a fever duration of one day was 553 (99.6%) in the baloxavir group and 6 (1.1%) in the oseltamivir group (p < 0.001). Baloxavir use was only significantly associated with fever duration in the multivariate analysis (odds ratio 50,201, p < 0.001). Apparent adverse effects were not observed in the baloxavir-treated group. Conclusions: Baloxavir treatment resulted in a shorter fever duration than oseltamivir treatment in early childhood influenza.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Fever Resolution in Early Childhood Influenza Treated with Baloxavir Marboxil: A Retrospective Study Compared to Those with Oseltamivir

Nezu,

Hayashida,

Nagano

et al. 2023

Medicina

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“…Notwithstanding, influenza severe disease is associated with 25% mortality, despite adequate Oseltamivir prescription [25 ▪▪ ]. Polymerase inhibitors, such as Baloxavir, have a role in viral replication and are positioning themselves as an alternative treatment [25 ▪▪ ,26,27 ▪ ]. It was firstly approved in Japan and in the USA in 2018, and later in 2021 in the EU and UK for uncomplicated influenza treatment in subjects older than 12 years old.…”

Section: Viral Pneumonia and Its Increasing Relevance Over Timementioning

confidence: 99%

Severe community-acquired pneumonia in the post COVID-19 era

Ruiz-Spinelli,

Waterer,

Rello

2023

Current Opinion in Critical Care

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Purpose of review The aim was to examine and summarize the most recent published literature in the last years stating the advances for treatment options and adjunctive therapies in patients hospitalized with severe community-acquired pneumonia (sCAP). Search was performed in PubMed, including observational studies, randomized controlled trials, systematic reviews and meta-analyses, and international guidelines. Recent findings Regardless of a large number of published CAP guidelines, most of their recommendations are based on low-level evidence. Viruses have an increasing role as sCAP etiology with an impact on mortality. Accordingly, it is imperative to strengthen the demand for vaccines and newer antivirals. Considering an early monitoring of the immune response in patients with severe Influenza, may help to evaluate a personalized immunomodulatory strategy. Despite growing evidence, the use of corticosteroids as an adjunctive therapy in bacterial sCAP continues to be controversial. Summary Mortality due to sCAP still remains undesirably high. This fact strengthens the need for more high-quality research to increase evidence. It also highlights the need for clinicians to be aware of the level of evidence of the stated recommendations, taking this into consideration before decision making.

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“…It also resulted in significant declines in viral titers compared with placebo or oseltamivir. 96 However, no results have been published regarding the use of baloxavir in those with severe influenza in the ICU. The results of a double blind RCT (NCT03684044) of baloxavir plus NAI versus placebo plus NAI in hospitalized patients with severe influenza are awaited, however they have been reported elsewhere as unsuccessful.…”

Section: Drug Therapiesmentioning

confidence: 99%

Management of Severe Influenza

O'Driscoll¹,

Martín‐Loeches

2021

Semin Respir Crit Care Med

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Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.

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Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: a meta-analysis of randomized controlled trials

Cited by 17 publications

References 38 publications

Early Fever Resolution in Early Childhood Influenza Treated with Baloxavir Marboxil: A Retrospective Study Compared to Those with Oseltamivir

Early Fever Resolution in Early Childhood Influenza Treated with Baloxavir Marboxil: A Retrospective Study Compared to Those with Oseltamivir

Severe community-acquired pneumonia in the post COVID-19 era

Management of Severe Influenza

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