Jiang Jiali, Wang Jianping, Hou Wenjing, Hu Bangqin, Chen Pan, Zeng Fang, Zhang Yan, Qian Qing, Ma Kuifen
Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Pharmacy, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Microbiol Spectr. 2025 Jul;13(7):e0295424. doi: 10.1128/spectrum.02954-24. Epub 2025 May 22.
Kidney transplant recipients (KTRs) are at high risk for severe influenza and its complications. The effectiveness of baloxavir marboxil (hereafter baloxavir) in infected KTRs is still unknown. In this multicenter retrospective study conducted at eight Grade IIIA hospitals in China, KTRs diagnosed with influenza between October 2023 and March 2024 were enrolled. Of the 246 patients assessed, 117 met the inclusion criteria. There were 59 patients who received baloxavir and 58 patients who received oseltamivir. Patients receiving baloxavir had a longer time from symptom onset to treatment (≤48 h, 59.3% versus 79.3%; = 0.019). Nevertheless, in comparison with those who were administered oseltamivir, they exhibited no statistically significant difference in time to alleviation of influenza symptoms [4 (2-6) versus 5 (3-7); = 0.054], duration of fever [3 (2-4) versus 3 (2-4); = 0.347], or viral clearance [6 (40.0%) versus 10 (58.8%); = 0.479]. However, among patients who received antivirals within 48 h, baloxavir showed a significant correlation with fever resolution when compared with oseltamivir [2 (2, 3) versus 3 (2-4); = 0.030]. Meanwhile, among patients who received antivirals after 48 h, a remarkable improvement of symptom alleviation in 5 days was observed in the baloxavir-treated group as compared to the oseltamivir-treated group [18 (75.0%) versus 2 (16.7%); = 0.001]. In conclusion, compared to oseltamivir, patients may derive benefits from baloxavir treatment within 48 h, but especially after 48 h from symptom onset.IMPORTANCEThe multicenter cohort study is the first to compare the clinical efficacy of baloxavir with oseltamivir in influenza kidney transplant recipients (KTRs). The results showed that there were fewer influenza symptoms but a longer time for viral shedding in KTRs compared to non-immunosuppressed patients. No significant difference regarding time to alleviation of influenza symptoms and fever resolution between baloxavir and oseltamivir was found, which is consistent with CAPSTONE-1, whereas influenza KTRs who received baloxavir could have a shorter fever duration and symptom alleviation in 5 days compared to the oseltamivir-treated group. Our findings may provide guidance for influenza therapy in KTRs, solid organ transplant recipients, and immunocompromised patients.
肾移植受者（KTRs）发生严重流感及其并发症的风险很高。玛巴洛沙韦（以下简称巴洛沙韦）在感染的KTRs中的有效性尚不清楚。在这项在中国八家三级甲等医院进行的多中心回顾性研究中，纳入了2023年10月至2024年3月期间诊断为流感的KTRs。在评估的246例患者中，117例符合纳入标准。其中59例患者接受了巴洛沙韦治疗，58例患者接受了奥司他韦治疗。接受巴洛沙韦治疗的患者从症状出现到治疗的时间更长（≤48小时，59.3%对79.3%；P = 0.019）。然而，与接受奥司他韦治疗的患者相比，他们在流感症状缓解时间[4（2 - 6）天对5（3 - 7）天；P = 0.054]、发热持续时间[3（2 - 4）天对3（2 - 4）天；P = 0.347]或病毒清除方面[6例（40.0%）对10例（58.8%）；P = 0.479]没有统计学上显著差异。然而，在48小时内接受抗病毒药物治疗的患者中，与奥司他韦相比，巴洛沙韦与发热消退显著相关[2（2，3）天对3（2 - 4）天；P = 0.030]。同时，在48小时后接受抗病毒药物治疗的患者中，与奥司他韦治疗组相比，巴洛沙韦治疗组在5天内症状缓解有显著改善[18例（75.0%）对2例（16.7%）；P = 0.001]。总之，与奥司他韦相比，患者在症状出现后48小时内，尤其是48小时后接受巴洛沙韦治疗可能会受益。重要性多中心队列研究首次比较了巴洛沙韦与奥司他韦在流感肾移植受者（KTRs）中的临床疗效。结果表明，与非免疫抑制患者相比，KTRs的流感症状较少，但病毒 shedding 时间较长。巴洛沙韦和奥司他韦在流感症状缓解时间和发热消退方面没有显著差异，这与CAPSTONE - 1一致，而与奥司他韦治疗组相比，接受巴洛沙韦治疗的流感KTRs发热持续时间可能更短，5天内症状缓解。我们的研究结果可能为KTRs、实体器官移植受者和免疫功能低下患者的流感治疗提供指导。
