Virological and clinical outcomes in outpatients treated with baloxavir or oseltamivir: A Japanese multicenter study in the 2019–2020 influenza season

Chong, Yong Pil; Kawai, Naoki; Tani, Naoki; Bando, Takuma; Takasaki, Yoshio; Shindo, Shizuo; Ikematsu, Hideyuki

doi:10.1016/j.antiviral.2021.105092

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…Favipiravir (T-705), an inhibitor of viral RNA polymerase, has been proven to be effective in the treatment of influenza viruses, including NAI-resistant variants, and is also a potential drug for treating Ebola virus disease virus (EVD) and severe acute respiratory syndrome coronavirus type 2 (SARS-cov-2) ( FangHuangLiChengTanLiu, 2020 ; DziedziejkoPawlik, 2021 ). Baloxavir marboxil (baloxavir), a novel influenza cap-dependent inhibitor of endonuclease-selective polymerase acidic protein, has shown clinical efficacy in rapidly reducing the viral load, shortening the duration of fever, and relieving symptoms ( Chong et al, 2021 ; Portsmouth et al, 2021 ). In addition, compared to the ineffectiveness of NAIs, the efficacy of single and combined use of favipiravir was excellent in vivo ( Imai et al, 2017 ; Wang et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Clinical Effectiveness of Oseltamivir for Influenza Treatment in Children

et al. 2022

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Objective: To estimate the clinical effectiveness of oseltamivir in children with different subtypes of influenza virus infection.Methods: A total of 998 children with acute respiratory infection were enrolled from January to March 2018, and were divided into influenza A, influenza B, influenza A + B, and non-influenza infection (IV-negative) groups. Influenza-like symptoms and duration of fever were evaluated and compared between oseltamivir-treated and non-treated groups.Results: There were no significant differences in the reduction in total febrile period and duration of fever from the onset of therapy between the oseltamivir treated and non-treated children infected with influenza A (p = 0.6885 for total febrile period and 0.7904 for the duration of fever from the onset of treatment), influenza B (p = 0.1462 and 0.1966), influenza A + B (p = 0.5568 and 0.9320), and IV-negative (p = 0.7631 and 0.4655). The duration of fever in children received oseltamivir therapy within 48 h was not significantly shorter than that beyond 48 h (p > 0.05). Additionally, percentages and severities of influenza-like symptoms, including headache, myalgia, fatigue, bellyache, vomiting, diarrhea, sore throat, cough, and coryza were not decreased and alleviated after treatment of oseltamivir.Conclusion: Oseltamivir treatment does not significantly shorten the duration of fever, nor does it significantly relieve influenza-like symptoms in children with infection of influenza.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the Clinical Effectiveness of Oseltamivir for Influenza Treatment in Children

et al. 2022

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“…Similar to NAIs, the emergence of resistance variants towards baloxavir happens with increasing prescriptions. I38X (T/M/F/N) contributed to most of the variants reported, which emerged in 2.2% to 9.7% of adult and adolescent groups [59,60 ▪▪ ,66,72 ▪ ], and up to 12.5% to 23.4% of the paediatric group [61,62,63 ▪▪ ,73] during the baloxavir treatment. Another type of variant, E23K, was detected at a lower incidence (1.3% to 1.5%) [64,72 ▪ ].…”

Section: Endonuclease Inhibitormentioning

confidence: 98%

“…A retrospective cohort found that baloxavir use was associated with a lower incidence of emergency visits and better cost savings, especially in high-risk patients, compared to oseltamivir [65]. Baloxavir has a higher viral suppressive effect than oseltamivir [59,66]. A simulation model suggested that the use of baloxavir within 48 h after symptom onset is effective in preventing influenza-related deaths in epidemic settings, and the effect could be doubled if it was administered within 24 h [67].…”

Section: Clinical Efficacy Of Endonuclease Inhibitormentioning

confidence: 99%

“…Global analysis on the frequency of viruses showing reduced susceptibility to baloxavir or carrying substitutions associated with reduced susceptibility was low (less than 0.5%) but it was higher in Japan (4.5%) probably due to extensive baloxavir usage [53]. Several studies had reported I38T/M variants were associated with longer TTAS [59,61], and longer duration of virus shedding [60 && ,61], although this was not consistently observed in other studies [66,73].…”

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confidence: 95%

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Antiviral therapies for influenza

Chan

Hui

2023

Current Opinion in Infectious Diseases

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Purpose of reviewThe heavily suppressed global influenza activity during the coronavirus disease 2019 (COVID-19) pandemic is expected to return upon relaxation of travel restriction and nonpharmaceutical interventions (NPI). We reviewed the four marketed neuraminidase inhibitors (NAI e.g., oseltamivir, zanamivir, peramivir, laninamivir) and the only endonuclease inhibitor (baloxavir) on their clinical therapeutic effects and the ability of viral suppression in various groups of patients of different clinical settings based on the latest evidence.Recent findingsEarly initiation, preferably within 48 h of symptom onsets, of antiviral treatments with NAI and baloxavir, is crucial to produce favourable outcomes in patients with influenza infection. Updated evidence does not suggest routine use of combined antiviral agents in patients with influenza infection. Treatment-emergent resistant influenza variants may occur during NAI and baloxavir use, but it has no major impact on subsequent recovery. Early treatment of index patients with influenza infection and post-exposure prophylaxis in specific populations is crucial in preventing influenza transmission.SummaryAntiviral therapy is the major defence therapeutically in the community and hospital settings to expedite early recovery and reduce influenza-related complications. Early treatment of index patients and post-exposure prophylaxis in susceptible close contacts may mitigate the spread of infection.

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“…However, some positive clinical observations have been published since the beginning of 2021. A recent clinical trial in Japan in children between 6 and 12 concluded that BXM was efficacious and safe for Japanese patients with influenza infection [24]. A comparison of the antiviral medicines in Japan showed that BXM reduced the rates of complications in patients suffering from flu [25].…”

Section: Medical Interestmentioning

confidence: 99%

Baloxavir Marboxil: An Original New Drug against Influenza

Dufrasne

2021

Pharmaceuticals

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Baloxavir marboxil is a new drug developed in Japan by Shionogi to treat seasonal flu infection. This cap-dependent endonuclease inhibitor is a prodrug that releases the biologically active baloxavir acid. This new medicine has been marketed in Japan, the USA and Europe. It is well tolerated (more than 1% of the patients experienced diarrhea, bronchitis, nausea, nasopharyngitis, and headache), and both influenza A and B viruses are sensitive, although the B strain is more resistant due to variations in the amino acid residues in the binding site. The drug is now in post-marketing pharmacovigilance phase, and its interest will be especially re-evaluated in the future during the annual flu outbreaks. It has been also introduced in a recent clinical trial against COVID-19 with favipiravir.

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Virological and clinical outcomes in outpatients treated with baloxavir or oseltamivir: A Japanese multicenter study in the 2019–2020 influenza season

Cited by 8 publications

References 12 publications

Evaluation of the Clinical Effectiveness of Oseltamivir for Influenza Treatment in Children

Evaluation of the Clinical Effectiveness of Oseltamivir for Influenza Treatment in Children

Antiviral therapies for influenza

Baloxavir Marboxil: An Original New Drug against Influenza

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