Higashiguchi Masayoshi, Matsumoto Tomoshige, Fujii Takashi
Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Hospital, Neyagawa City, Osaka, Japan.
Antivir Ther. 2018;23(2):157-165. doi: 10.3851/IMP3189.
Laninamivir octanoate is a recently developed inhaled neuraminidase inhibitor for treating influenza virus infection. We performed meta-analyses to clarify the efficacy of laninamivir octanoate on influenza treatment and prevention.
MEDLINE and CENTRAL were searched to identify eligible studies. The log median time to event ratios (logMRs) and log odds ratios (logORs) were combined with meta-analysis.
Nine studies in treatment settings and three studies in prophylaxis settings were eligible for this meta-analysis. There was no significant difference between laninamivir octanoate and oseltamivir (8 studies, logMR 0.04, 95% CI [-0.05, 0.14]; P=0.36) or zanamivir (4 studies, logMR -0.01, 95% CI [-0.12, 0.11]; P=0.93) in alleviating fever. However, laninamivir octanoate was associated with significantly longer fever duration in treating H3N2 influenza as compared to oseltamivir (4 studies, logMR 0.29, 95% CI [0.00, 0.59]; P=0.047). Laninamivir octanoate was associated with significantly longer duration of fever as compared to peramivir (4 studies, logMR 0.46, 95% CI [0.14, 0.77]; P=0.004). Laninamivir octanoate significantly reduced the incidence of clinical influenza in post-exposure settings (3 studies, logOR -1.17, 95% CI [-1.72, -0.62]; P<0.001).
Overall, the efficacy of laninamivir octanoate in treating influenza was comparable to that of oseltamivir or zanamivir, but it should be noted that laninamivir octanoate was associated with significantly longer fever duration in treating influenza H3N2 as compared to oseltamivir and oseltamivir-resistant mutations in seasonal influenza H1N1 might have affected the results. Peramivir may be superior to laninamivir in treating influenza. Laninamivir octanoate is effective in preventing influenza in post-exposure settings as compared to placebo.
辛酸拉尼米韦是一种最近研发的用于治疗流感病毒感染的吸入性神经氨酸酶抑制剂。我们进行了荟萃分析以阐明辛酸拉尼米韦在流感治疗和预防方面的疗效。
检索MEDLINE和CENTRAL以确定符合条件的研究。将事件对数中位时间比（logMRs）和对数比值比（logORs）进行荟萃分析合并。
9项治疗相关研究和3项预防相关研究符合本荟萃分析的条件。在缓解发热方面，辛酸拉尼米韦与奥司他韦（8项研究，logMR 0.04，95%CI[-0.05, 0.14]；P = 0.36）或扎那米韦（4项研究，logMR -0.01，95%CI[-0.12, 0.11]；P = 0.93）之间无显著差异。然而，与奥司他韦相比，在治疗H3N2流感时，辛酸拉尼米韦的发热持续时间显著更长（4项研究，logMR 0.29，95%CI[0.00, 0.59]；P = 0.047）。与帕拉米韦相比，辛酸拉尼米韦的发热持续时间显著更长（4项研究，logMR 0.46，95%CI[0.14, 0.77]；P = 0.004）。在暴露后环境中，辛酸拉尼米韦显著降低了临床流感的发生率（3项研究，logOR -1.17，95%CI[-1.72, -0.62]；P<0.001）。
总体而言，辛酸拉尼米韦治疗流感的疗效与奥司他韦或扎那米韦相当，但应注意，与奥司他韦相比，辛酸拉尼米韦治疗H3N2流感时发热持续时间显著更长，且季节性H1N1流感中的奥司他韦耐药突变可能影响了结果。在治疗流感方面，帕拉米韦可能优于辛酸拉尼米韦。与安慰剂相比，辛酸拉尼米韦在暴露后环境中预防流感有效。
