1. Time in hospital was modestly reduced in both intervention groups compared to the control.

2. There was little to no improvement in symptom alleviation with oseltamivir and peramivir compared to control.

Evidence Rating Level: 1 (Excellent)

Study Rundown: There is little consensus around the first-line antiviral treatment for severe influenza. This systematic review of randomized controlled trials assessed different antivirals used in hospitalized patients with severe influenza. This study aimed to assess the effectiveness of various antiviral drugs, including oseltamivir, peramivir, and zanamivir, in reducing important clinical outcomes compared to placebo or standard care. The primary outcome of this study was the reduction in length-of-hospital-stay, while a key secondary outcome was time to symptom alleviation. According to study results, oseltamivir and peramivir have the potential to modestly reduce the duration of hospital stay while the effect on mortality remains unclear. This study was limited by a small number of eligible trials and low certainty of evidence, which hinders drawing strong conclusions about the benefits of these antivirals.

Click to read the study in The Lancet

Relevant Reading: Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents

In-depth [systematic review and meta-analysis]: This systematic review and meta-analysis identified 11,878 trials published up to Sept 2023 across all databases. Included were studies with patients hospitalized due to suspected or confirmed severe influenza who received direct-acting antiviral treatment. Altogether, 8 trials involving 1,424 participants were included in the final analysis. The primary outcome of duration of hospital stay was modestly reduced in the oseltamivir (mean difference -1.63 days, 95% confidence interval [CI] -2.81 to -0.45) and peramivir (-1.73 days, 95% CI -3.33 to -0.13) groups compared to standard care. The secondary outcome of symptom alleviation showed minimal to no improvement with oseltamivir (0.34 days; low certainty evidence) and peramivir (-0.05 days; low certainty evidence). Findings from this study suggest that while oseltamivir and peramivir may shorten hospital stays in patients with severe influenza, the overall benefit on mortality remains uncertain.

Image: PD

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