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A systematic review and meta-analysis published in JAMA Internal Medicine has raised questions about the effectiveness of antivirals recommended for nonsevere influenza cases. The study examined 73 randomized controlled trials spanning over five decades, encompassing 34,332 participants with influenza who did not require hospitalization within the first two days of symptom onset.
Key findings indicate that commonly used antivirals—oseltamivir (Tamiflu), zanamivir (Relenza), and peramivir (Rapivab)—provide little to no benefit in reducing mortality, hospitalization rates, or symptom duration for nonsevere cases. However, baloxavir (Xofluza) emerged as a potentially promising option, albeit with certain caveats.
Study Highlights:
- Oseltamivir and Zanamivir:
These drugs showed negligible effects on hospitalization rates and mortality. Oseltamivir, in particular, was associated with gastrointestinal side effects. - Peramivir:
Demonstrated little to no impact on symptom duration or mortality, with no available data regarding hospitalization effects. - Baloxavir:
Reduced hospitalization rates for high-risk patients with “low certainty” evidence and decreased symptom duration by a day with moderate certainty. However, 10% of patients treated with baloxavir experienced antiviral resistance.
Despite its potential, baloxavir faces challenges in accessibility, with limited pharmacy availability and high out-of-pocket costs, averaging $200 without insurance.
Expert Reactions:
Dr. Maja Artandi, a professor at Stanford University, expressed surprise at the findings, emphasizing the reliance on antivirals over the years despite their limited effectiveness. She plans to incorporate baloxavir more into her practice, though insurance coverage remains a hurdle.
Conversely, Dr. Arthi Balu from the University of California, San Diego, questioned the study’s implications for oseltamivir, maintaining its use for high-risk patients like the elderly and those with chronic illnesses.
Dr. Laura Polito, a family medicine physician at the University of Washington Medicine, noted that while baloxavir has fewer side effects than oseltamivir, its cost and availability limit its utility in urgent care settings.
Conclusion:
The study underscores the need for more effective antiviral treatments for influenza, particularly for nonsevere cases. Researchers advocate for careful prescription practices and the monitoring of antiviral resistance, particularly with baloxavir.
Disclaimer: This article is intended for informational purposes only and does not constitute medical advice. Patients should consult healthcare professionals for personalized treatment decisions.
