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Abstract
Antiviral drugs are an important measure of control for influenza in the population, particularly for those that are severely ill or hospitalised. The neuraminidase inhibitor (NAI) class of drugs, including oseltamivir, have been the standard of care (SOC) for severe influenza illness for many years. The approval of drugs with novel mechanisms of action, such as baloxavir marboxil, is important and broadens potential treatment options for combination therapy. The use of antiviral treatments in combination for influenza is of interest; one potential benefit of this treatment strategy is that the combination of drugs with different mechanisms of action may lower the selection of resistance due to treatment. In addition, combination therapy may become an important treatment option to improve patient outcomes in those with severe illness due to influenza or those that are immunocompromised. Clinical trials increasingly evaluate drug combinations in a range of patient cohorts. Here, we summarise preclinical and clinical advances in combination therapy for the treatment of influenza with reference to immunocompromised animal models and clinical data in hospitalised patient cohorts where available. There is a wide array of drug categories in development that have also been tested in combination. Therefore, in this review, we have included polymerase inhibitors, monoclonal antibodies (mAbs), host-targeted therapies, and adjunctive therapies. Combination treatment regimens should be carefully evaluated to determine whether they provide an added benefit relative to effectiveness of monotherapy and in a variety of patient cohorts, particularly, if there is a greater chance of an adverse outcome. Safe and effective treatment of influenza is important not only for seasonal influenza infection, but also if a pandemic strain was to emerge.
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Kumar D, Ison MG, Mira JP, Welte T, Hwan Ha J, Hui DS, Zhong N, Saito T, Katugampola L, Collinson N, Williams S, Wildum S, Ackrill A, Clinch B, Lee N. Combining baloxavir marboxil with standard-of-care neuraminidase inhibitor in patients hospitalised with severe influenza (FLAGSTONE): a randomised, parallel-group, double-blind, placebo-controlled, superiority trial. THE LANCET INFECTIOUS DISEASES 2022; 22:718-730. [DOI: 10.1016/s1473-3099(21)00469-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 10/19/2022]
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Taniguchi K, Ando Y, Kobayashi M, Toba S, Nobori H, Sanaki T, Noshi T, Kawai M, Yoshida R, Sato A, Shishido T, Naito A, Matsuno K, Okamatsu M, Sakoda Y, Kida H. Characterization of the In Vitro and In Vivo Efficacy of Baloxavir Marboxil against H5 Highly Pathogenic Avian Influenza Virus Infection. Viruses 2022; 14:v14010111. [PMID: 35062315 PMCID: PMC8777714 DOI: 10.3390/v14010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
Human infections caused by the H5 highly pathogenic avian influenza virus (HPAIV) sporadically threaten public health. The susceptibility of HPAIVs to baloxavir acid (BXA), a new class of inhibitors for the influenza virus cap-dependent endonuclease, has been confirmed in vitro, but it has not yet been fully characterized. Here, the efficacy of BXA against HPAIVs, including recent H5N8 variants, was assessed in vitro. The antiviral efficacy of baloxavir marboxil (BXM) in H5N1 virus-infected mice was also investigated. BXA exhibited similar in vitro activities against H5N1, H5N6, and H5N8 variants tested in comparison with seasonal and other zoonotic strains. Compared with oseltamivir phosphate (OSP), BXM monotherapy in mice infected with the H5N1 HPAIV clinical isolate, the A/Hong Kong/483/1997 strain, also caused a significant reduction in viral titers in the lungs, brains, and kidneys, thereby preventing acute lung inflammation and reducing mortality. Furthermore, compared with BXM or OSP monotherapy, combination treatments with BXM and OSP using a 48-h delayed treatment model showed a more potent effect on viral replication in the organs, accompanied by improved survival. In conclusion, BXM has a potent antiviral efficacy against H5 HPAIV infections.
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Affiliation(s)
- Keiichi Taniguchi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshinori Ando
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Masanori Kobayashi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Shinsuke Toba
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Haruaki Nobori
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takao Sanaki
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takeshi Noshi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Makoto Kawai
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Ryu Yoshida
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Akihiko Sato
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Takao Shishido
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Correspondence: ; Tel.: +81-6-6331-7263
| | - Akira Naito
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Keita Matsuno
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Masatoshi Okamatsu
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshihiro Sakoda
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Hiroshi Kida
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
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Angelidakis G, Khawaja F, Mulanovich VE, Dailey-Garnes N, Ariza-Heredia E, Chemaly RF. Combination of Baloxavir and Oseltamivir for Treatment of Severe Influenza Infection in Hematopoietic Cell Transplant Recipients: A Novel Treatment Strategy for a High-risk Population. Microbes Infect 2021; 24:104895. [PMID: 34756990 DOI: 10.1016/j.micinf.2021.104895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022]
Abstract
Baloxavir, a cap-dependent endonuclease inhibitor, was recently approved for treatment of severe influenza infections. Combining baloxavir with oseltamivir has been proposed to increase the response rate. We report 2 hematopoietic cell transplant recipients with severe influenza infections who were treated with this combination and discuss possible reasons for their different responses.
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Affiliation(s)
- Georgios Angelidakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fareed Khawaja
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie Dailey-Garnes
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ella Ariza-Heredia
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ishida T, Seki M, Oishi K, Tateda K, Fujita J, Kadota JI, Kawana A, Izumikawa K, Kikuchi T, Ohmagari N, Yamada M, Maruyama T, Takazono T, Miki M, Miyazaki Y, Yamazaki Y, Kakeya H, Ogawa K, Nagai H, Watanabe A. Clinical manifestations of adult patients requiring influenza-associated hospitalization: A prospective multicenter cohort study in Japan via internet surveillance. J Infect Chemother 2020; 27:480-485. [PMID: 33189538 DOI: 10.1016/j.jiac.2020.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Influenza remains a clinically heavy burden worldwide. The objective of this study was to clarify clinical manifestations of severely ill patients infected with influenza. METHODS The clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2019 (5 influenza seasons) using an internet-surveillance system. RESULTS A total of 924 patients were enrolled and analyzed. The median age was 78 years (IQR, 67-84), and the patients in the 2015-2016 season were significantly younger than those in other seasons. Pneumonia was the most common disease indicated as a cause for hospitalization, followed by a poor general condition and exacerbation of underlying respiratory diseases. Antiviral drugs were administered in 97.0% of the patients with peramivir being the most-frequently use antiviral. In-hospital death was recorded for 44 patients (4.8%). Multivariate analysis indicated that nursing home resident (OR: 6.554) and obesity (OR: 24.343) were independent predictors of in-hospital mortality. CONCLUSIONS Complications of influenza infection remain a heavy burden especially among the elderly. Continuous nationwide surveillance will be required to grasp the actual situation of influenza epidemics. (UMIN000015989).
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Affiliation(s)
- Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1, Kurashiki, Okayama, 710-8602, Japan.
| | - Masafumi Seki
- Department of Infectious Diseases, Tohoku Medical and Pharmaceutical University, 4-4-1, Komatsushima, Aobaku, Sendai, Miyagi, 981-8558, Japan
| | - Kazunori Oishi
- Toyama Institute of Health, 17-1, Nakataikouyama, Imizu, Toyama, 939-0363, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University, 5-21-6, Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, 207 Azaujihara, Nisiharacho, Nakatou, Okinawa, 903-0215, Japan
| | - Jun-Ichi Kadota
- Nagasaki City Hospital Organization, Nagasaki Harbor Medical Center, 6-39, Shinchicho, Nagasaki, 850-8555, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 751, Ichibancho, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1, Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takaya Maruyama
- Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, 357, Kubotacho, Osato, Tsu, Mie, 514-0125, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Miki
- Department of Pulmonary and Respiratory Medicine, Japanese Red Cross Sendai Hospital, 2-43-3, Yamamotocho, Yagi, Taihaku-ku, Sendai, 982-8501, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, Leprosy Research Center, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Yoshitaka Yamazaki
- Division of Infectious Diseases, Shinsyu Medical Center, 1332, Suzaka, Nagano, 382-0091, Japan
| | - Hiroshi Kakeya
- Department of Infectious Control Science, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Ogawa
- Department of Respiratory Medicine, National Hospital Organization Higashinagoya National Hospital, 5-101, Umemorizaka, Higashi-ku, Nagoya, Aichi, 465-8620, Japan
| | - Hideaki Nagai
- Department of Infectious Diseases, National Hospital Organization, Tokyo National Hospital, 3-1-1, Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Akira Watanabe
- Division for Development of Anti-infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, 6-45-1, Kunimi, Aoba-ku, Sendai, 981-8551, Japan
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