Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: a meta-analysis of randomized controlled trials

Scarce evidence verifying the clinical impact of baloxavir on influenza complications is found. PubMed, Cochrane Library, and Web of Science databases were searched through December 2020. Randomized-controlled trials (RCT) that enrolled patients with laboratory-confirmed influenza receiving neuraminidase inhibitors (NAI) or baloxavir comparing to placebo were assessed. PROSPERO Registration-number: CRD42021226854. Twenty-one RCTs (11,697 patients) were included. Antiviral administration significantly reduced time to clinical resolution (mean difference: −21.3 hours) and total influenza-related complications (OR:0.55, 95%CI: 0.42–0.73). Specifically, antivirals significantly decreased bronchitis (OR:0.54, 95%CI: 0.38–0.75), sinusitis (OR:0.51, 95%CI: 0.33–0.78), acute otitis media (OR:0.48, 95%CI: 0.30–0.77), and antibiotic prescription (OR:0.62; 95%CI: 0.48–0.80). A positive trend favored antivirals administration to reduce pneumonia (OR:0.47, 95%CI: 0.16–1.33), or hospitalization rates (OR:0.65; 95%CI: 0.34–1.24) compared to placebo, but did not reach statistical significance. Adverse events (AE) were reported in 11%, 8.9%, and 5.1% of NAIs, placebo and baloxavir recipients, respectively. Compared with NAIs, administration of baloxavir showed non-significantly reduced AEs (OR:0.74, 95%CI: 0.53–1.04). Single-dose baloxavir and NAIs were superior to placebo to reduce complications in uncomplicated influenza, with 40% significant reduction in antibiotic prescription. Safety and efficacy of single-dose baloxavir were non-inferior to NAIs.