Sato Masatoki
Department of Pediatrics, Fukushima Medical University.
Fukushima J Med Sci. 2025 Jan 18;71(1):1-12. doi: 10.5387/fms.24-00029. Epub 2024 Dec 18.
Since 2000, rapid antigen detection kits and anti-influenza drugs have been used for the early diagnosis and treatment of influenza in Japan, respectively. The main drugs available in clinical practice are the neuraminidase inhibitors oseltamivir, zanamivir, laninamivir, and peramivir, as well as the cap-dependent endonuclease inhibitor baloxavir marboxil. Antiviral therapy with neuraminidase inhibitors has been practiced for many years, especially in Japan; it can shorten the febrile period and reduce complications. Despite having similar structures, the pharmacologic background of neuraminidase inhibitors differs significantly, as reflected in their varying clinical efficacy. Due to its inhibitory mechanism, baloxavir marboxil can rapidly reduce the viral load than neuraminidase inhibitors. However, the duration of symptoms was similar after the administration of baloxavir marboxil and oseltamivir, and variants with reduced drug susceptibility have been detected in 20%-30% of pediatric patients treated with baloxavir marboxil. Clinical trials of several novel anti-influenza drugs are currently underway. When these drugs are first marketed, the characteristics of the influenza virus and the pharmacologic background of the drugs must be clarified before their administration to patients in clinical practice.
自2000年以来，快速抗原检测试剂盒和抗流感药物已分别在日本用于流感的早期诊断和治疗。临床实践中可用的主要药物是神经氨酸酶抑制剂奥司他韦、扎那米韦、拉尼米韦和帕拉米韦，以及帽依赖性核酸内切酶抑制剂巴洛沙韦酯。使用神经氨酸酶抑制剂进行抗病毒治疗已经有很多年了，尤其是在日本；它可以缩短发热期并减少并发症。尽管结构相似，但神经氨酸酶抑制剂的药理背景差异很大，这体现在它们不同的临床疗效上。由于其抑制机制，巴洛沙韦酯比神经氨酸酶抑制剂能更快降低病毒载量。然而，服用巴洛沙韦酯和奥司他韦后症状持续时间相似，在接受巴洛沙韦酯治疗的20%-30%的儿科患者中检测到了药物敏感性降低的变异体。目前正在进行几种新型抗流感药物的临床试验。当这些药物首次上市时，在临床实践中将其应用于患者之前，必须明确流感病毒的特征和药物的药理背景。
