tetano
Editor, Senior Moderator
Expert Rev Clin Pharmacol
. 2021 Apr 16.
doi: 10.1080/17512433.2021.1917378. Online ahead of print.
Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: a meta-analysis of randomized controlled trials
Sof?a Tejada[SUP] 1 2 [/SUP], Alexandre M Tejo[SUP] 3 [/SUP], Yolanda Pe?a-L?pez[SUP] 2 4 [/SUP], Carlos G Forero[SUP] 5 [/SUP], Xavier Corbella[SUP] 5 6 [/SUP], Jordi Rello[SUP] 1 2 7 [/SUP]
Affiliations
Abstract
Background: Scarce evidence verifying the clinical impact of baloxavir on influenza complications is found.
Methods: PubMed, Cochrane Library and Web of Science databases were searched through December 2020. Randomized-controlled trials (RCT) that enrolled patients with laboratory confirmed influenza receiving neuraminidase inhibitors (NAI) or baloxavir comparing to placebo were assessed. PROSPERO Registration-number: CRD42021226854.
Results: A total of 21 RCTs, recruiting 11,697 patients, were included. Administration of antivirals significantly reduced time to clinical resolution (mean difference: -21.3 hours); and total influenza-related complications (OR:0.55, 95%CI: 0.42-0.73). Specifically, antivirals significantly decreased bronchitis (OR:0.54, 95%CI: 0.38-0.75), sinusitis (OR:0.51, 95%CI: 0.33-0.78), acute otitis media (OR:0.48, 95%CI: 0.30-0.77), and antibiotic prescription (OR:0.62; 95%CI: 0.48-0.80). A positive trend favored antivirals administration to reduce pneumonia (OR:0.47, 95%CI: 0.16-1.33), or hospitalization rates (OR:0.65; 95%CI: 0.34-1.24) compared to placebo, but did not reach statistical significance. Adverse events (AE) were reported in 11%, 8.9% and 5.1% of NAIs, placebo and baloxavir recipients, respectively. Compared with NAIs, administration of baloxavir showed non-significantly reduced AEs (OR:0.74, 95%CI: 0.53-1.04).
Conclusions: Single-dose baloxavir and NAIs were superior to placebo to reduce complications in uncomplicated influenza, with 40% significant reduction in antibiotic prescription. Safety and efficacy of single-dose baloxavir was non-inferior to NAIs.
Keywords: Baloxavir marboxil; Influenza; Neuraminidase Inhibitors; Oseltamivir; Peramivir; Zanamivir.
. 2021 Apr 16.
doi: 10.1080/17512433.2021.1917378. Online ahead of print.
Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: a meta-analysis of randomized controlled trials
Sof?a Tejada[SUP] 1 2 [/SUP], Alexandre M Tejo[SUP] 3 [/SUP], Yolanda Pe?a-L?pez[SUP] 2 4 [/SUP], Carlos G Forero[SUP] 5 [/SUP], Xavier Corbella[SUP] 5 6 [/SUP], Jordi Rello[SUP] 1 2 7 [/SUP]
Affiliations
- PMID: 33861168
- DOI: 10.1080/17512433.2021.1917378
Abstract
Background: Scarce evidence verifying the clinical impact of baloxavir on influenza complications is found.
Methods: PubMed, Cochrane Library and Web of Science databases were searched through December 2020. Randomized-controlled trials (RCT) that enrolled patients with laboratory confirmed influenza receiving neuraminidase inhibitors (NAI) or baloxavir comparing to placebo were assessed. PROSPERO Registration-number: CRD42021226854.
Results: A total of 21 RCTs, recruiting 11,697 patients, were included. Administration of antivirals significantly reduced time to clinical resolution (mean difference: -21.3 hours); and total influenza-related complications (OR:0.55, 95%CI: 0.42-0.73). Specifically, antivirals significantly decreased bronchitis (OR:0.54, 95%CI: 0.38-0.75), sinusitis (OR:0.51, 95%CI: 0.33-0.78), acute otitis media (OR:0.48, 95%CI: 0.30-0.77), and antibiotic prescription (OR:0.62; 95%CI: 0.48-0.80). A positive trend favored antivirals administration to reduce pneumonia (OR:0.47, 95%CI: 0.16-1.33), or hospitalization rates (OR:0.65; 95%CI: 0.34-1.24) compared to placebo, but did not reach statistical significance. Adverse events (AE) were reported in 11%, 8.9% and 5.1% of NAIs, placebo and baloxavir recipients, respectively. Compared with NAIs, administration of baloxavir showed non-significantly reduced AEs (OR:0.74, 95%CI: 0.53-1.04).
Conclusions: Single-dose baloxavir and NAIs were superior to placebo to reduce complications in uncomplicated influenza, with 40% significant reduction in antibiotic prescription. Safety and efficacy of single-dose baloxavir was non-inferior to NAIs.
Keywords: Baloxavir marboxil; Influenza; Neuraminidase Inhibitors; Oseltamivir; Peramivir; Zanamivir.