Summary

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• Rapivab (peramivir) is indicated for the treatment of acute uncomplicated influenza in patients 6 months and older who have been symptomatic for no more than two days.
• This summary is based on the review of 10 systematic review(s)/meta-analysis(es). ^[1-10]
• Oseltamivir (300 mg/day for 5 days) reduced time to fever alleviation by -19.1 hours compared to placebo. Baloxavir (40 mg/day) reduced time to symptom alleviation by -28.2 hours. Peramivir (300 mg/day) reduced time to resumption of usual activities by -43.5 hours. Peramivir (300 mg single dose) reduced time to symptom alleviation by -17.68 hours; 600 mg Peramivir by -16.15 hours. Zanamivir and Oseltamivir also showed efficacy with mean differences between 12.78 to 19.51 hours.
• Baloxavir and neuraminidase inhibitors (NAIs) reduced time to clinical resolution by -21.3 hours and decreased influenza-related complications (OR: 0.55). Peramivir showed higher efficacy in time to alleviation of symptoms (TTAS) with a mean difference (MD) of -11.214 hours. Baloxavir had significantly greater virus titer reduction in high-risk patients compared to Oseltamivir and Peramivir.
• Baloxavir and NAIs reduced incidences of bronchitis, sinusitis, acute otitis media, and antibiotic prescriptions, with trends suggesting reduced pneumonia and hospitalization rates.
• Peramivir demonstrated higher efficacy in TTAS compared to Baloxavir and Laninamivir, with Zanamivir associated with the shortest TTAS among treatments. Baloxavir showed superior antiviral activity, particularly in high-risk patients, with overall efficacy comparable to other NAIs.
• Baloxavir demonstrated a lower incidence of AEs (5.1%) compared to neuraminidase inhibitors (NAIs) (11%) and placebo (8.9%). Baloxavir was associated with the lowest risk of total adverse events.
• Oseltamivir was linked to increased occurrences of nausea and vomiting, with NAIs showing a significant increase in these symptoms (OR: 1.61). Peramivir had a similar incidence of AEs (RR = 1.023) and serious AEs (RR = 1.068) as Oseltamivir.
• Baloxavir presented a similar safety profile to other antivirals and had a lower risk of drug-related adverse events in high-risk patients.
• Oseltamivir, Baloxavir, Peramivir, Zanamivir, and Laninamivir were evaluated for efficacy and safety in healthy young and middle-aged adults with seasonal influenza, high-risk patients, and otherwise healthy patients, showing comparable efficacy across these groups, with Baloxavir demonstrating superior antiviral activity in high-risk patients.