Results of a systematic review and meta-analysis of 4 antiviral agents for the treatment of influenza, published in JAMA Network Open, showed that the risk for influenza-related complications was best decreased by baloxavir, and zanamivir had the shortest time to alleviation of symptoms (TTAS).
Researchers from Taipei Medical University searched publication databases for clinical trials that compared neuraminidase and endonuclease inhibitors with each other and placebo for the treatment of seasonal influenza. The primary endpoints were TTAS, disease-associated complications, and adverse event risk.
The meta-analysis comprised a total of 11,897 patients from 26 studies. Of the patients, 52.9% were men and the mean age was 32.5 (standard deviation [SD], 16.9) years. Data were sourced from both adult and pediatric patients. Patients were randomly assigned to receive either placebo or 1 of 4 antiviral agents: oseltamivir 75 mg or 150 mg twice daily, zanamivir 10 mg twice daily, peramivir 300 mg or 600 mg once daily, or a single 40- or 80-mg dose of baloxavir.
Compared with placebo, treatment with zanamivir 10 mg was associated with the shortest TTAS (hazard ratio [HR], 0.67; 95% CI, 0.58-0.77), followed by peramivir 600 mg (HR, 0.69; 95% CI, 0.54-0.88), oseltamivir 75 mg (HR, 0.74; 95% CI, 0.70-0.79), oseltamivir 150 mg (HR, 0.75; 95% CI, 0.65-0.86), peramivir 300 mg (HR, 0.75; 95% CI, 0.62-0.91), and baloxavir 40 mg or 80 mg (HR, 0.79; 95% CI, 0.73-0.86). The researchers found no evidence of heterogeneity (I2, 0%) or global evidence of inconsistency among the treatment comparisons (c24, 2.37; P =.67).
Compared with placebo, treatment with baloxavir at either the 40 mg or 80 mg dose most significantly decreased the risk for influenza-related complications (risk ratio [RR], 0.51; 95% CI, 0.32-0.80), followed by oseltamivir 75 mg (RR, 0.61; 95% CI, 0.49-0.75), and zanamivir 10 mg (RR, 0.82; 95% CI, 0.72-0.92). Similar to the comparative analysis of treatments with the shortest TTAS, the researchers observed no evidence of heterogeneity (I2, 0%) or global evidence of inconsistency (c29, 5.05; P =.83).
In regard to adverse events risk, only treatment with baloxavir at either the 40 mg or 80 mg dose (RR, 0.84; 95% CI, 0.74-0.96) was associated with a significantly decreased risk compared with placebo (I2, 0%; c28, 6.42; P =.60).
The researchers reported evidence of potential publication bias (P =.049), which may have limited their analyses.
“Meta-analysis studies such as this may have utility in informing treatment guidelines for [influenza] when few direct comparisons between individual therapies are available,” the researchers concluded.
Liu J-W, Lin S-H, Wang L-C, Chiu H-Y, Lee J-A. Comparison of antiviral agents for seasonal influenza outcomes in healthy adults and children: a systematic review and network meta-analysis. JAMA Netw Open. 2021;4(8):e2119151. doi:10.1001/jamanetworkopen.2021.19151