Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Pharmacoepidemiol Drug Saf. 2021 Jun;30(6):779-786. doi: 10.1002/pds.5207. Epub 2021 Mar 1.
Baloxavir marboxil is a novel antiviral agent for influenza, introduced into clinical practice in 2018. A concern remains about the variant virus with reduced susceptibility after baloxavir exposure and its clinical consequences such as healthcare-seeking behavior.
Using a healthcare database in Japan, we compared the medical resource use following baloxavir and neuraminidase inhibitors (NAIs) treatment among children aged 7-15 years. The study period was from December 2018 to March 2019. The primary endpoint was the composite of hospitalization, laboratory and radiological tests, and antibiotic use over 1-9 days of antiviral treatment. As exploratory analyses, secondary outcomes being each single component of the primary composite were assessed and subgroup analyses comparing baloxavir with each NAI were done.
Data from 115 867 prescriptions in 115 238 children were analyzed (median age: 10 years; severe influenza risk in 26%; baloxavir accounting for 43%). Overall, baloxavir use did not increase subsequent medical resource utilization in the composite endpoint (adjusted odds ratio [aOR]: 1.04; 95% confidence interval [CI]: 0.99-1.09; P = 0.14), as were likelihoods of other secondary outcomes. In the subgroup analysis, baloxavir use was associated with higher medical resource use than oseltamivir (aOR: 1.21; 95% CI: 1.13-1.31; P < 0.001) and lower resource use than zanamivir (aOR: 0.93; 95% CI 0.86-1.00; P = 0.040).
Based on a single-year experience in Japan, prescribing baloxavir rather than NAIs did not increase medical resource utilization within 9 days of treatment, except in one exploratory comparison with oseltamivir.
巴洛沙韦马立克是一种新型抗流感病毒药物，于 2018 年引入临床实践。人们仍然担心在巴洛沙韦暴露后出现对变异病毒的敏感性降低及其临床后果，例如寻求医疗保健的行为。
我们使用日本的一个医疗保健数据库，比较了 7-15 岁儿童使用巴洛沙韦和神经氨酸酶抑制剂（NAI）治疗后的医疗资源使用情况。研究期间为 2018 年 12 月至 2019 年 3 月。主要终点是抗病毒治疗 1-9 天内住院、实验室和影像学检查以及抗生素使用的综合结果。作为探索性分析，评估了主要复合结果的每个单一组成部分，并且比较了巴洛沙韦与每种 NAI 的亚组分析。
共分析了 115238 例儿童的 115717 份处方数据（中位数年龄：10 岁；严重流感风险为 26%；巴洛沙韦占 43%）。总体而言，巴洛沙韦的使用并未增加复合终点的后续医疗资源利用（调整后的优势比[aOR]：1.04；95%置信区间[CI]：0.99-1.09；P=0.14），其他次要结局的可能性也如此。在亚组分析中，与奥司他韦相比，巴洛沙韦的使用与更高的医疗资源利用相关（aOR：1.21；95%CI：1.13-1.31；P<0.001），与扎那米韦相比，资源利用较低（aOR：0.93；95%CI 0.86-1.00；P=0.040）。
根据日本一年的经验，除了与奥司他韦的一项探索性比较外，与使用 NAI 相比，开具巴洛沙韦而不是 NAI 并没有在治疗后 9 天内增加医疗资源的利用。
