Written by Megan Hilbert
For treatment of non-severe influenza, there has not been an identified antiviral medication that should be used for treatment instead of simple symptomatic management.
It’s flu season and I’m flying through treatment options
In January we covered early oseltamivir for severe influenza cases admitted to the hospital, but now we are widening our scope. This systematic review of randomized controls compared influenza antiviral drugs to placebo, standard of care, no intervention, and other antiviral medications in patients with non-severe influenza.
There were 9 drugs and 11 outcomes evaluated. Let’s break it down into the most important take-away points.
- Mortality: High-certainty evidence demonstrates that compared to standard of care or placebo there is little to no effect of mortality in low-risk patients for any of the medications.
- Admission to hospital: Baloxavir may reduce risk of admission for high-risk patients (difference -16 per 1000; 95%CI -20 to 4; low certainty). There was no difference in admission for low-risk patients for any of the medications.
- Time to alleviation of symptoms: There was a mean decrease in symptom duration of 1.02 days for baloxavir (95%CI -1.41 to -0.63; moderate certainty), 1.10 days for umifenovir (95%CI -1.57 to -0.63; low certainty), and less than 1 day for oseltamivir (95%CI -0.93 to -0.57; moderate certainty) and zanamivir (95%CI -0.93 to -04.3; moderate certainty).
- Adverse events: Baloxavir did not increase overall adverse events (difference, -52 per 1000; 95%CI -87 to -17; high certainty) or adverse events related to treatment (difference, -32 per 1000; 95%CI -52 to -6; high certainty). Oseltamivir likely increased adverse events related to treatment (difference, +28 per 1000; 95%CI 12 to 48; moderate certainty).
- Emergence of resistance: Baloxavir may have had an important impact on drug resistance (9.97%; 95%CI 0.02%-31.79%F; low certainty).
How does this change my practice?
While I applaud this review and the pertinence of the clinical question, it doesn’t change my clinical practice. While there are more drugs that can be used on non-severe influenza than I imagined, none demonstrate high enough certainty evidence (without concern for developing resistance – I’m looking at you, baloxavir!) to warrant initiating these medications for patients with influenza.
Source
Antiviral Medications for Treatment of Nonsevere Influenza: A Systematic Review and Network Meta-Analysis. JAMA Intern Med. 2025 Jan 13. doi: 10.1001/jamainternmed.2024.7193. Epub ahead of print. PMID: 39804622
