Antivirals for post-exposure prophylaxis of influenza: a systematic review and network meta-analysis
Notice bibliographique
Résumé
Abstract Background To support an update of WHO influenza guidelines, we performed a systematic review and network meta-analysis of the evidence on antiviral drugs for prophylaxis of influenza. Methods We analyzed randomized controlled trials published as of September 2023 on the efficacy and safety of antivirals compared to another antiviral or placebo, standard care, or no prophylaxis for prevention of symptomatic influenza. Paired reviewers independently screened studies, extracted data and assessed the risk of bias. We used frequentist random effects to perform network meta-analyses and assessed the certainty of evidence using the grading of recommendations assessment, development and evaluation (GRADE) methodology. Findings We included thirty-three trials of six antivirals (zanamivir, oseltamivir, laninamivir, baloxavir, amantadine, and rimantadine) that enrolled 19096 individuals. Zanamivir, oseltamivir, laninamivir and baloxavir probably achieve important reductions in symptomatic influenza in persons at high risk of severe disease (moderate certainty) when given promptly after exposure to seasonal influenza. These antivirals probably do not achieve important reductions in symptomatic influenza in persons at low risk of severe disease when given promptly after exposure to seasonal influenza (moderate certainty). Zanamivir, oseltamivir, laninamivir and baloxavir might achieve important reductions in symptomatic zoonotic influenza in persons exposed to novel influenza A viruses associated with severe disease in infected humans when given promptly after exposure (low certainty). These antivirals do not result in an important incidence of adverse events related to drugs or serious adverse events, with varying certainty of evidence. Interpretation Post-exposure prophylaxis with zanamivir, oseltamivir, laninamivir or baloxavir probably decreases the risk of symptomatic seasonal influenza in persons at high risk for severe disease after exposure to seasonal influenza viruses. Post-exposure prophylaxis with zanamivir, oseltamivir, laninamivir or baloxavir might reduce the risk of symptomatic zoonotic influenza after exposure to novel influenza A viruses associated with severe disease in infected humans. Funding WHO. Research in context Evidence before this study Antivirals can be used to prevent influenza in people who have close contact to sick persons or animals infected with influenza viruses. Although previous reviews have found that antivirals (oseltamivir, zanamivir) are effective in preventing symptomatic influenza, these reviews assessed selected antivirals and did not rate the quality of evidence or consider the importance of effects in their interpretation. Additionally, a randomized controlled trial (RCT) of baloxavir for influenza post-exposure prophylaxis was not included in previous reviews. Added value of this study This systematic review and network meta-analyses of RCTs addressing antiviral prophylaxis against influenza was performed in support of a World Health Organisation (WHO) guidelines development group panel to formulate recommendations on use of antivirals for influenza. We present our analyses of the efficacy of antiviral prophylaxis to prevent symptomatic influenza for high or low-risk (non-high-risk) populations and for preventing symptomatic zoonotic influenza. We found moderate certainty evidence that zanamivir, oseltamivir, laninamivir and baloxavir all probably result in an important reduction in the risk of symptomatic seasonal influenza in high-risk persons when given promptly after exposure, but probably have no important effect for low-risk populations. Rimantadine probably has little or no effect on symptomatic seasonal influenza A virus infection (moderate certainty). Zanamivir, oseltamivir, laninamivir and baloxavir may decrease the risk of symptomatic zoonotic influenza (low certainty). The evidence for amantadine to prevent influenza A virus infection is limited. All of these antivirals have no important impact on adverse events. Implications of the available evidence The findings of this systematic review and network meta-analysis support use of zanamivir, oseltamivir, laninamivir or baloxavir for post-exposure prophylaxis of seasonal influenza in persons at high risk of severe influenza, and also provide some support for the use of these antivirals for post-exposure prophylaxis of zoonotic influenza. The systematic review did not support using these antivirals among low-risk populations for post-exposure prophylaxis of seasonal influenza and did not support the use of amantadine and rimantadine for preventing symptomatic influenza A virus infection.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,038 | 0,078 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,021 | 0,035 |
| Bibliométrie | 0,009 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».