Clinical Efficacy of Oseltamivir and Baloxavir Marboxil in Influenza A and B: A Systematic Review and Meta-Analysis
Author(s)
Cécile Grobet, MSc, Linda Vinci, MSc, Flurina Meier Schwarzer, MSc, Yaroslava Zemlyanska, MSc, Christina Tzogiou, PhD.
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
OBJECTIVES: In Switzerland, oseltamivir and baloxavir marboxil are approved for the treatment and prevention of influenza A and B. To inform strategic stockpiling decisions, a clinical evidence synthesis was conducted to evaluate the efficacy and safety of both antivirals compared to each other, placebo, or non-antiviral treatment, for both treatment and prophylaxis of influenza.
METHODS: A systematic review of randomised controlled trials was conducted. Meta-analyses were performed where data allowed; remaining outcomes were summarised narratively. Risk of bias was assessed, and the certainty of evidence was evaluated.
RESULTS: Both antivirals significantly reduced influenza-associated complications, such as pneumonia, bronchitis or otitis media, compared to placebo: from 13% to 8% with oseltamivir and from 10% to 3% with baloxavir marboxil. Time to alleviation of influenza symptoms was significantly shorter with oseltamivir and baloxavir marboxil compared to placebo (mean difference: -23.74 hours and -26.39 hours, respectively). Mortality was rarely reported in the included studies, with no statistically significant differences observed between oseltamivir and placebo. Hospitalisations were infrequent, with no statistically significant difference detected between oseltamivir and placebo. Adverse events did not differ significantly between oseltamivir and placebo but were significantly less frequent with baloxavir marboxil than with oseltamivir. In prophylactic use, oseltamivir reduced the incidence of laboratory-confirmed influenza from 14% to 8 %, and baloxavir marboxil from 13% to 2 %, compared to placebo.
CONCLUSIONS: Oseltamivir and baloxavir marboxil reduce influenza-associated complications and shorten symptom duration by approximately one day. Neither drug showed a significant effect on mortality or hospitalisation. Baloxavir marboxil was associated with fewer adverse events compared to oseltamivir. In prophylaxis, both antivirals reduced the risk of confirmed influenza. Overall, the clinical benefits of oseltamivir and baloxavir marboxil appear modest.
METHODS: A systematic review of randomised controlled trials was conducted. Meta-analyses were performed where data allowed; remaining outcomes were summarised narratively. Risk of bias was assessed, and the certainty of evidence was evaluated.
RESULTS: Both antivirals significantly reduced influenza-associated complications, such as pneumonia, bronchitis or otitis media, compared to placebo: from 13% to 8% with oseltamivir and from 10% to 3% with baloxavir marboxil. Time to alleviation of influenza symptoms was significantly shorter with oseltamivir and baloxavir marboxil compared to placebo (mean difference: -23.74 hours and -26.39 hours, respectively). Mortality was rarely reported in the included studies, with no statistically significant differences observed between oseltamivir and placebo. Hospitalisations were infrequent, with no statistically significant difference detected between oseltamivir and placebo. Adverse events did not differ significantly between oseltamivir and placebo but were significantly less frequent with baloxavir marboxil than with oseltamivir. In prophylactic use, oseltamivir reduced the incidence of laboratory-confirmed influenza from 14% to 8 %, and baloxavir marboxil from 13% to 2 %, compared to placebo.
CONCLUSIONS: Oseltamivir and baloxavir marboxil reduce influenza-associated complications and shorten symptom duration by approximately one day. Neither drug showed a significant effect on mortality or hospitalisation. Baloxavir marboxil was associated with fewer adverse events compared to oseltamivir. In prophylaxis, both antivirals reduced the risk of confirmed influenza. Overall, the clinical benefits of oseltamivir and baloxavir marboxil appear modest.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO46
Topic
Clinical Outcomes, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas