A SYSTEMATIC review and meta-analysis evaluating antiviral medications for nonsevere influenza provides new insights into the optimal treatments for symptom relief and hospitalization risks, particularly for high-risk patients. The findings, drawn from 73 trials and over 34,000 participants, highlight key differences in efficacy and adverse outcomes across available antiviral options.
The study analyzed data from randomized clinical trials comparing direct-acting antiviral drugs to standard care, placebo, or other antivirals. It assessed critical outcomes, including mortality, hospital admissions, symptom duration, resistance emergence, and adverse effects.
Key Findings:
Hospital Admissions: Baloxavir demonstrated potential to reduce hospital admission risk for high-risk patients with nonsevere influenza (risk difference [RD], −1.6%; 95% CI, −2.0 to 0.4; low certainty). In contrast, oseltamivir showed little or no impact on hospitalization rates for the same group (RD, −0.4%; 95% CI, −1.0 to 0.4; high certainty).
Symptom Relief: Baloxavir likely shortened symptom duration (mean difference [MD], −1.02 days; 95% CI, −1.41 to −0.63; moderate certainty). Oseltamivir had minimal impact on symptom duration (MD, −0.75 days; 95% CI, −0.93 to −0.57; moderate certainty).
Adverse Events: Baloxavir was associated with fewer adverse effects (RD, −3.2%; 95% CI, −5.2 to −0.6; high certainty), whereas oseltamivir likely increased adverse events (RD, 2.8%; 95% CI, 1.2 to 4.8; moderate certainty).
The study concluded that baloxavir may offer the most benefit for high-risk patients with nonsevere influenza by reducing hospitalizations and shortening symptom duration, without increasing treatment-related adverse events. Other antiviral drugs showed either minimal or uncertain effects on these outcomes.
Reference: Gao Y et al. Antiviral Medications for Treatment of Nonsevere Influenza. JAMA Intern Med. 2025. doi:10.1001/jamainternmed.2024.7193.
