Abstract
The persistent global burden of seasonal and pandemic influenza highlights the need for next-generation antivirals that limit the viral transmission and improve epidemic or pandemic management. Baloxavir marboxil, a cap-dependent endonuclease inhibitor, offers a distinct advantage by rapidly inhibiting viral replication with a single-dose regimen. Recent clinical findings indicate that it not only alleviates symptoms but also reduces person-to-person transmission by cessation of viral shedding more effectively than neuraminidase inhibitors. Moreover, as intrafamilial household transmission remains a primary driver of seasonal outbreaks and epidemics in Japan and globally, numerous studies have evaluated the effectiveness of antiviral-based preventive and suppressive strategies. Hence, in this review, we comprehensively evaluated the effects of baloxavir treatment on transmission suppression and prophylaxis. We found that treatment of index patients with baloxavir substantially reduced viral transmission to contacts, while prophylactic use in uninfected contacts reduced the risk of clinical influenza. We also compared baloxavir with neuraminidase inhibitors using clinical, nonclinical, and model-based studies, with evidence suggesting the superior efficacy of baloxavir in preventing onward transmission. In view of these observations, future research should assess transmission dynamics across diverse community settings beyond the household, while simultaneously investigating innovative combination treatments for improved influenza management.
Source:
Link: https://www.mdpi.com/1999-4915/18/11/1200
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