Baloxavir shows promise in patients with nonsevere influenza

In the treatment of patients with nonsevere influenza virus infection, baloxavir may reduce the risk of hospital admission and shorten the time to symptom relief, according to the results of a systematic review and meta-analysis.

Researchers searched multiple online databases for randomized clinical trials in which direct-acting influenza antiviral drugs were compared with placebo, standard care, or another antiviral for the treatment of patients with nonsevere influenza.

A total of 73 trials involving 34,332 participants met the eligibility criteria and were included. A frequentist network meta-analysis was used to synthesize the evidence, while the GRADE approach was applied to evaluate the certainty of evidence. Outcomes of interest were mortality, admission to hospital, admission to the intensive care unit, duration of hospitalization, time to alleviation of symptoms, emergence of resistance, and adverse events.

Pooled data showed that compared with standard care or placebo, all antiviral drugs either had little or no effect on mortality for low-risk and high-risk patients (all high certainty) and on hospital admission (no data for peramivir and amantadine) for low-risk patients (high certainty).

For hospital admission in high-risk patients, specifically, oseltamivir had little to no effect (risk difference [RD], −0.4 percent, 95 percent confidence interval [CI], −1.0 to 0.4; high certainty), whereas baloxavir showed a protective effect (RD, −1.6 percent, 95 percent CI, −2.0 to 0.4; low certainty). All other drugs had little or uncertain effect.

For time to alleviation of symptoms, the duration was shorter with baloxavir (mean difference [MD], −1.02 days, 95 percent CI, −1.41 to −0.63; moderate certainty) and umifenovir (MD, −1.10 days, 95 percent CI, −1.57 to −0.63; low certainty). Oseltamivir, on the other hand, had no important effect (MD, −0.75 days, 95 percent CI, −0.93 to −0.57; moderate certainty).

For adverse events related to treatment, baloxavir was associated with few or no adverse events (RD, −3.2 percent, 95 percent CI, −5.2 to −0.6; high certainty), whereas oseltamivir was associated with increased adverse events (RD, 2.8 percent, 95 percent CI, 1.2–4.8; moderate certainty).