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Chest
Published in Henry J. Woodford, Essential Geriatrics, 2022
Neuraminidase inhibitors have been developed for the treatment of influenza. They include the orally-taken oseltamivir and the inhaled zanamivir. They are thought to be able to reduce viral exit from host cells. These drugs need to be started early in infectious episodes. A Cochrane review found that oseltamivir reduced the duration of influenza symptoms by around 17 hours (95% CI 8 to 25 hours), representing a symptom duration of 6.3 days compared to seven with placebo.58 Results with zanamivir were similar. There was no reduction in hospitalisations and uncertain effects on pneumonia. Nausea and vomiting were more common with oseltamivir. Prophylaxis with these drugs, for people exposed, reduced the risk of developing symptomatic influenza.
Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
The neuraminidase inhibitors, oseltamivir and zanamivir, are modestly effective against both influenza A (including H1N1) and influenza B. Although the manufacturer has conducted no studies to assess safety of these medications for pregnant women, available risk-benefit data suggest that pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy. Information about peramivir in pregnancy is limited to a handful of cases treated under the FDA's Emergency Use Authorization, and no recommendation can be made about this drug.
Infections
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Resistance to neuraminidase inhibitors has been demonstrated in vitro but appears to be rare in humans. The pathogenic strength of mutant strains is reduced in animals and remains unknown in humans. Gastrointestinal side effects have been reported in 10% of adults. Vomiting may be reduced in children if the oseltamivir is taken during meals. Zanamivir by aerosol must be used with care for asthmatic patients, for whom it would be better to prescribe oseltamivir.
The use of antiviral drugs in children
Published in Journal of Chemotherapy, 2022
Marco Antonio Motisi, Agnese Tamborino, Sara Parigi, Luisa Galli, Maurizio de Martino, Elena Chiappini
Neuraminidase promotes the release of the virion from the infected host cell. Neuraminidase inhibitors are active against influenza type A and B viruses. Zanamivir is approved by the EMA for inhalation by children over the age of five. The dose is similar to that indicated for adults: two 5 mg inhalations twice daily for five days. Oseltamivir is approved by the EMA from birth age, administered twice daily for five days. Both drugs are also approved for post-exposure prevention. A systematic review involving 74 studies carried out in 2012 showed a reduction in the duration of influenza symptoms, complication rates and mortality with zanamivir and oseltamivir [10]. This success and the presence of viral strains with neuraminidase mutations that may affect their binding to oseltamivir led to the subsequent development of two more drugs in this class: peramivir, which can be administered intravenously in a single dose and is approved by the EMA for treatment in children over the age of two but not for post-exposure prophylaxis, and laninamavir, which has been approved in Japan for use in adults and children since 2010 and can be administered by inhalation in a single dose. Laninamivir has also proven effective against oseltamivir-resistant virus strains in adults [11]. It is used by inhalation as a single dose (40 mg over the age of ten and 20 mg under the age of ten), and is also approved in Japan for post-exposure prophylaxis.
Single and multiple dose pharmacokinetics and safety of ZSP1273, an RNA polymerase PB2 protein inhibitor of the influenza A virus: a phase 1 double-blind study in healthy subjects
Published in Expert Opinion on Investigational Drugs, 2021
Yue Hu, Haijun Li, Min Wu, Hong Zhang, Yanhua Ding, Yun Peng, Xiaojiao Li, Zhenxiang Yu
Due to its high susceptibility to antigenic variation, it can develop life-threatening complications left untreated such as pneumonia though this tends to self resolved. The acute phase of influenza is usually managed by supportive therapy and antiviral drugs within 24 hours of symptom onset that can decrease the duration of illness and the risk of serious complications. However, antiviral drugs such as neuraminidase inhibitors and viral M2 protein inhibitors have their own limitations [10]. For example, neuraminidase inhibitors should be administered within 48 h of infection, whereas M2 protein inhibitors (amantadine and rimantadine) are no longer used due to the potential adverse effects (AEs) and drug resistance [11]. Neuraminidase inhibitors such as oseltamivir and zanamivir act directly on viral proteins to halt the spread of infection [12]. However, due to the high mutation rate and recombination between influenza virus strains, the efficacy of the existing anti-influenza drugs is limited. Oseltamivir-resistant mutations have become increasingly apparent [13], and similar to H1N1, have been reported in various subtypes including H3N2, H5N1 (avian influenza in Asia), and H7N9 [14]. To meet the increasingly severe public health issues and clinical necessities, there is an urgent need to develop novel anti-influenza drugs that target viral genes/proteins and enhanced clinical effectiveness.
Cost-effectiveness of baloxavir marboxil compared with laninamivir for the treatment of influenza in patients at high risk for complications in Japan
Published in Current Medical Research and Opinion, 2021
Mariia Dronova, Hidetoshi Ikeoka, Naoya Itsumura, Nobuo Hirotsu, Amir Ansaripour, Samuel Aballéa, Yoshie Onishi, Mark Hill, Ataru Igarashi
For the purpose of the cost-effectiveness analysis in the Japanese setting, the choice of the comparator for baloxavir was performed in line with the official guideline for economic evaluations in Japan10,11. It is recommended to select the comparator from technologies which are expected to be replaced by the evaluated technology. Among them, technologies which are widely used in clinical practice and which result in a better outcome should be selected. It is unclear, to date, which of the neuraminidase inhibitors performs better. However, according to reports of the Ministry of Health, Labour and Welfare of Japan (MHLW), laninamivir was the most often prescribed anti-influenza drug for adolescents and adults in Japan in the 2015/2016 to 2017/2018 influenza seasons (before the launch of baloxavir)12,13. Baloxavir became the most used antiviral in the following season (2018/2019), when laninamivir had the second largest market.5 It should be also noted that laninamivir was considered as the price comparator for baloxavir14. Therefore, laninamivir was chosen as an appropriate comparator for baloxavir.