A network meta-analysis of the efficacy and safety of baloxavir marboxil versus neuraminidase inhibitors for the treatment of influenza in otherwise healthy patients
A network meta-analysis of the efficacy and safety of baloxavir marboxil versus neuraminidase inhibitors for the treatment of influenza in otherwise healthy patients
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DOI：
10.1080/03007995.2019.1584505
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发表时间：
2019-08-03
影响因子：
2.3
通讯作者：
Hirotsu, Nobuo
中科院分区：
文献类型：
--
作者：
Taieb, Vanessa;Ikeoka, Hidetoshi;Hirotsu, Nobuo
目的：巴洛沙韦(Baloxavir marboxil，Baloxavir marboxil)是第一个单剂量口服治疗流感的帽依赖性核酸内切酶抑制剂。这项网络荟萃分析(NMA)评估了在其他健康患者中，与其他抗病毒药物相比，巴洛沙韦治疗流感的有效性和安全性。方法：2016年11月14日在Medline、Embase、Central和ICHUSHI进行系统的文献综述，以确定评估抗流感病毒药物的随机对照试验。进行了一项包括22项试验的NMA，以比较巴洛沙韦与其他抗病毒药物的疗效和安全性。结果：与扎那米韦相比，巴拉沙韦缓解所有症状的时间明显缩短(中位时间19.96h，95%CRI[3.23，39.07])。与扎那米韦和奥司他韦相比，巴拉沙韦组停止病毒脱落的时间明显缩短(47.00h；95%CRI[28.18，73.86]和56.03h[33.74，87.86])。从基线到24小时，巴洛沙韦的病毒滴度平均下降幅度明显大于其他药物。其他疗效结果的差异并不显著。在安全性方面，巴洛沙韦与其他抗病毒药物之间没有显著差异，但与奥司他韦和拉尼米韦相比，巴拉沙韦表现出的与药物相关的所有不良反应都有所减少。结论：NMA建议，与具有相似安全性的其他抗病毒药物相比，巴洛沙韦显示出更好或相似的疗效。与扎那米韦、奥司他韦和帕拉米韦相比，巴拉沙韦显著降低了病毒滴度，与扎那米韦和奥司他韦相比，减少了病毒的脱落。
Objective: Baloxavir marboxil (baloxavir) is the first cap-dependent endonuclease inhibitor being studied for the treatment of influenza in single oral dosing regimen. This network meta-analysis (NMA) evaluated the efficacy and safety of baloxavir compared to other antivirals for influenza in otherwise healthy patients. Methods: A systematic literature review was performed on 14 November 2016 in Medline, Embase, CENTRAL, and ICHUSHI to identify randomized controlled trials assessing antivirals for influenza. A NMA including 22 trials was performed to compare the efficacy and safety of baloxavir with other antivirals. Results: The time to alleviation of all symptoms was significantly shorter for baloxavir compared to zanamivir (difference in median time 19.96 h; 95% CrI [3.23, 39.07]). The time to cessation of viral shedding was significantly shorter for baloxavir than zanamivir and oseltamivir (47.00 h; 95% CrI [28.18, 73.86] and 56.03 h [33.74, 87.86], respectively). The mean decline in virus titer from baseline to 24 h was significantly greater for baloxavir than for the other drugs. Other differences in efficacy outcomes were not significant. No significant differences were found between baloxavir and the other antivirals for safety, except total drug-related adverse events where baloxavir demonstrated a decrease compared to oseltamivir and laninamivir. Conclusions: The NMA suggests that baloxavir demonstrated better or similar efficacy results compared to other antivirals with a comparable safety profile. Baloxavir led to a significant decrease in viral titer versus zanamivir, oseltamivir and peramivir and decreased viral shedding versus zanamivir and oseltamivir.