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Ge X, Chen Y, Wu W, Lu J, Wang Y, Li Z. Safety and effectiveness of baloxavir marboxil and oseltamivir for influenza in children: a real-world retrospective study in China. Front Pediatr 2024; 12:1418321. [PMID: 39135856 PMCID: PMC11317237 DOI: 10.3389/fped.2024.1418321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
Objectives To evaluate the safety and effectiveness of baloxavir marboxil (baloxavir) and oseltamivir in pediatric influenza patients in China. Methods Patients filling a prescription for baloxavir or oseltamivir within 48 h following an influenza-related outpatient visit were identified in Children's Hospital of Fudan University in China between March 2023 and December 2023. Outcomes were assessed after antiviral treatment and included the incidence of adverse reactions and the duration of fever and other flu symptoms. Results A total of 1430 patients infected with influenza A were collected and 865 patients (baloxavir: n = 420; oseltamivir: n = 445) finally included. The incidence of adverse reactions of nausea and vomiting was significantly different between the baloxavir group (2.38%) and the oseltamivir group (12.13%) [P < 0.001, OR = 4.2526, 95%CI (2.0549, 9.6080)]. No differences in other adverse reactions were observed between the two groups. The mean duration of fever in baloxavir group (1.43d) was significantly shorter than that in oseltamivir group (2.31d) [P < 0.001, 95%CI (0.7815, 0.9917)]. There were no differences in the mean duration of nasal congestion and runny nose, sore throat, cough, and muscle soreness between two groups. Conclusions The incidence of nausea and vomiting is lower with baloxavir compared to oseltamivir, and the duration for complete fever reduction is shorter with baloxavir than with oseltamivir. The results indicate that baloxavir is well tolerated and effective in Chinese children.
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Affiliation(s)
- Xilin Ge
- Department of Pharmacy,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Chen
- Department of Pharmacy,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Wu
- Department of Pharmacy,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jinmiao Lu
- Department of Pharmacy,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiping Li
- Department of Pharmacy,National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Slavish PJ, Cuypers MG, Rimmer MA, Abdolvahabi A, Jeevan T, Kumar G, Jarusiewicz JA, Vaithiyalingam S, Jones JC, Bowling JJ, Price JE, DuBois RM, Min J, Webby RJ, Rankovic Z, White SW. Chemical scaffold recycling: Structure-guided conversion of an HIV integrase inhibitor into a potent influenza virus RNA-dependent RNA polymerase inhibitor designed to minimize resistance potential. Eur J Med Chem 2023; 247:115035. [PMID: 36603507 DOI: 10.1016/j.ejmech.2022.115035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
Influenza is one of the leading causes of disease-related mortalities worldwide. Several strategies have been implemented during the past decades to hinder the replication cycle of influenza viruses, all of which have resulted in the emergence of resistant virus strains. The most recent example is baloxavir marboxil, where a single mutation in the active site of the target endonuclease domain of the RNA-dependent-RNA polymerase renders the recent FDA approved compound ∼1000-fold less effective. Raltegravir is a first-in-class HIV inhibitor that shows modest activity to the endonuclease. Here, we have used structure-guided approaches to create rationally designed derivative molecules that efficiently engage the endonuclease active site. The design strategy was driven by our previously published structures of endonuclease-substrate complexes, which allowed us to target functionally conserved residues and reduce the likelihood of resistance mutations. We succeeded in developing low nanomolar equipotent inhibitors of both wild-type and baloxavir-resistant endonuclease. We also developed macrocyclic versions of these inhibitors that engage the active site in the same manner as their 'open' counterparts but with reduced affinity. Structural analyses provide clear avenues for how to increase the affinity of these cyclic compounds.
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Affiliation(s)
- Peter J Slavish
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Maxime G Cuypers
- Structural Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Mary Ashley Rimmer
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Alireza Abdolvahabi
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Trushar Jeevan
- Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Gyanendra Kumar
- Structural Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jamie A Jarusiewicz
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | | | - Jeremy C Jones
- Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - John J Bowling
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jeanine E Price
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Rebecca M DuBois
- Baskin School of Engineering, University of California at Santa Cruz, Santa Cruz, CA, 95064, USA
| | - Jaeki Min
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Richard J Webby
- Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Zoran Rankovic
- Departments of Chemical Biology & Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
| | - Stephen W White
- Structural Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
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Wagatsuma K, Saito R, Chon I, Phyu WW, Fujio K, Kawashima T, Sato I, Saito T, Minato M, Kodo N, Suzuki E, Ono Y, Masaki H, Shirahige Y, Kitano A, Hamabata H, Yuyang S, Jiaming L, Watanabe H. Duration of fever and symptoms in influenza-infected children treated with baloxavir marboxil during the 2019–2020 season in Japan and detection of influenza virus with the PA E23K substitution. Antiviral Res 2022; 201:105310. [DOI: 10.1016/j.antiviral.2022.105310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/26/2022]
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Ison MG, Hayden FG, Hay AJ, Gubareva LV, Govorkova EA, Takashita E, McKimm-Breschkin JL. Influenza polymerase inhibitor resistance: Assessment of the current state of the art - A report of the isirv Antiviral group. Antiviral Res 2021; 194:105158. [PMID: 34363859 PMCID: PMC9012257 DOI: 10.1016/j.antiviral.2021.105158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
It is more than 20 years since the neuraminidase inhibitors, oseltamivir and zanamivir were approved for the treatment and prevention of influenza. Guidelines for global surveillance and methods for evaluating resistance were established initially by the Neuraminidase Inhibitor Susceptibility Network (NISN), which merged 10 years ago with the International Society for influenza and other Respiratory Virus Diseases (isirv) to become the isirv-Antiviral Group (isirv-AVG). With the ongoing development of new influenza polymerase inhibitors and recent approval of baloxavir marboxil, the isirv-AVG held a closed meeting in August 2019 to discuss the impact of resistance to these inhibitors. Following this meeting and review of the current literature, this article is intended to summarize current knowledge regarding the clinical impact of resistance to polymerase inhibitors and approaches for surveillance and methods for laboratory evaluation of resistance, both in vitro and in animal models. We highlight limitations and gaps in current knowledge and suggest some strategies for addressing these gaps, including the need for additional clinical studies of influenza antiviral drug combinations. Lessons learned from influenza resistance monitoring may also be helpful for establishing future drug susceptibility surveillance and testing for SARS-CoV-2.
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Affiliation(s)
- Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Alan J Hay
- The Francis Crick Institute, London, UK.
| | - Larisa V Gubareva
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Elena A Govorkova
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Emi Takashita
- National Institute of Infectious Diseases, Tokyo, Japan.
| | - Jennifer L McKimm-Breschkin
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia.
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