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Shandong University-led study reveals baloxavir’s potential to reduce hospitalizations and shorten symptoms without increasing side effects.
In a breakthrough study, researchers from Shandong University, China, have found that baloxavir, an endonuclease inhibitor, could offer a promising alternative for treating nonsevere influenza in high-risk patients. The systematic review and meta-analysis, published in JAMA Internal Medicine, analyzed data from 73 randomized clinical trials involving over 34,000 participants and compared various antiviral treatments.
Influenza, a viral respiratory illness, affects millions globally and can lead to serious complications and death. Current antiviral treatments, such as oseltamivir (Tamiflu), zanamivir (Relenza), and the newly introduced baloxavir (Xofluza), aim to reduce symptoms and complications by targeting viral replication and spread.
The meta-analysis explored the efficacy and safety of direct-acting antivirals, including baloxavir, oseltamivir, zanamivir, and others, against placebo or standard care. Notably, baloxavir was found to reduce symptom duration by 1.02 days in high-risk patients, with moderate certainty in the results. Additionally, it may lower the risk of hospitalization for these patients, though the evidence remains less certain.
The study emphasized that baloxavir did not significantly affect mortality rates in either high-risk or low-risk patients, with high-certainty evidence confirming no noticeable difference in mortality. Furthermore, adverse events linked to baloxavir were found to be lower than those associated with placebo, demonstrating its favorable safety profile.
In contrast, oseltamivir, a widely used antiviral, showed minimal impact on mortality and hospital admissions for both high-risk and low-risk groups. Oseltamivir also provided only a modest reduction in symptom duration (0.75 days) and was associated with a higher rate of adverse events.
While other antiviral options like zanamivir, laninamivir, and umifenovir showed varying levels of effectiveness, their impact on key outcomes was inconsistent, and evidence quality ranged from moderate to very low. For some drugs, data on hospitalization and ICU admissions were insufficient.
The findings suggest that baloxavir could be a better option for high-risk individuals, especially when considering its potential to reduce hospitalization and symptom duration without a significant increase in adverse events. However, researchers noted gaps in evidence, particularly concerning ICU admissions, antiviral resistance, and the long-term impact of treatments, which call for further investigation.
The study’s lead author, Ya Gao, emphasized the need for additional research with more focused patient outcomes to address these knowledge gaps and solidify baloxavir’s position in influenza management.
For more information, see the full study in JAMA Internal Medicine (DOI: 10.1001/jamainternmed.2024.7193).
This research is a significant step toward understanding the comparative benefits of antiviral medications in treating nonsevere influenza, particularly in vulnerable populations.
