Clinical outcomes of baloxavir versus oseltamivir in patients hospitalized with influenza A

Abstract

Objectives To date, clinical trials evaluating baloxavir have excluded patients hospitalized with influenza infection and therefore this study sought to evaluate the efficacy of baloxavir in inpatients with influenza A. Methods This study was a multicentre, retrospective chart review of adult patients admitted to the hospital within the Yale New Haven Health System who received oseltamivir or baloxavir for the treatment of influenza A. Patients were screened for inclusion between January 2018 and April 2018 in the oseltamivir group, while patients in the baloxavir group were screened for inclusion between January 2019 and April 2019. Influenza A diagnosis was confirmed by RT–PCR using a nasopharyngeal swab specimen. Results Of the 2392 patients assessed, 790 met the inclusion criteria. There were 359 patients who received baloxavir and 431 patients who received oseltamivir. Patients who received baloxavir were younger compared with those who received oseltamivir [median = 69 (IQR = 57–81) years versus 77 (IQR = 62–86) years; P < 0.001]. Patients who received baloxavir had no significant difference in hospital length of stay [median = 4 (IQR = 3–6) days versus 5 (IQR = 3–6) days; P = 0.45] or 30 day all-cause mortality [12 (3.3%) versus 26 (6%); P = 0.079] compared with those who received oseltamivir. However, patients who received baloxavir had a significantly faster time to hypoxia resolution [median = 51.7 (IQR = 25.3–89.3) h versus 72 (IQR = 37.5–123) h; P < 0.001]. Conclusions The results of this study support the use of baloxavir for the treatment of influenza A in hospitalized patients with the potential benefit of a faster time to resolution of hypoxia.

Influenza: clinical aspects, diagnosis, and treatment

“…In a phase III trial on hospitalized patients with severe influenza, combination therapy of baloxavir and oseltamivir showed mixed results; the combination did not result in superior clinical outcomes, but there was significantly better virologic response and viral culture clearance when compared to osel-tamivir alone [28 ▪▪ ]. In a retrospective study, balox-avir when compared to oseltamivir alone was found to be similar in its effect on hospital length of stay or 30-day all cause mortality, but did have produce a faster time to hypoxia resolution [29 ▪ ]. Further investigations are needed to elucidate its effect in other at-risk populations, including immunocompromised and transplant patients [30].…”

Antiviral therapies for influenza

“…A simulation model suggested that the use of baloxavir within 48 h after symptom onset is effective in preventing influenza-related deaths in epidemic settings, and the effect could be doubled if it was administered within 24 h [67]. For hospitalized patients with influenza A, a multicentre, retrospective study found that patients who received baloxavir had no significant difference in hospital length of stay or 30-day all-cause mortality, but a significantly faster time to hypoxia resolution than those who received oseltamivir [68]. Currently, there is a lack of safety and efficacy for baloxavir in pregnant and postpartum women [30].…”

Virologische Erkrankungen auf der Intensivstation

“…Bei der zuletzt genannten Studie zeigten alle Influenzapatienten ein fast doppelt so hohes Mortalitätsrisiko (51 % vs. 28 %), wenn gleichzeitig eine invasive pulmonale Aspergillose (IPA) vorlag [33]. [37].…”