Inavir (laninamivir) / Daiichi Sankyo, Vaxart - LARVOL DELTA

Bacteremic Group A Streptococcal Co-Infection in Two Adults with H3N2 Influenza in Japan, 2025-2026: A Case Series. (PubMed, Int Med Case Rep J) - "Case 2: A 68-year-old woman with no underlying disease was admitted as influenza A. She received laninamivir inhalation on Day -1 and had history of the influenza vaccine for the season...These cases highlight the severity of influenza-GAS co-infection during a season in which H3N2 subclade K predominated. Early antiviral treatment within 48 hours, vaccination, and high index of suspicion for invasive GAS in influenza patients with shock will be needed."

Journal • Acute Kidney Injury • Critical care • Infectious Disease • Inflammation • Influenza • Nephrology • Pneumococcal Infections • Pneumonia • Renal Disease • Respiratory Diseases

Critical updates in the 2024 influenza clinical practice guidelines of the World Health Organization. (PubMed, Infect Dis Immun) - "Baloxavir is not recommended for non-severe cases without severe risk factors, and other antivirals like oseltamivir, laninamivir, peramivir, zanamivir, favipiravir, and arbidol are not recommended for non-severe patients...Resource availability and co-infections can influence guideline implementation. Further research is needed to identify optimal strategies for specific populations."

Clinical guideline • Journal • Infectious Disease • Influenza • Obesity • Respiratory Diseases

Fragment Molecular Orbital Calculation Analysis of Influenza Neuraminidase and Inhibitor Interactions (PubMed, Yakugaku Zasshi) - "The interactions between four compounds used as influenza neuraminidase inhibitors-oseltamivir, zanamivir, laninamivir, and peramivir- and influenza virus neuraminidase were analyzed using pair interaction energy decomposition analysis based on fragment molecular orbital (FMO) method, quantitatively elucidating binding characteristics of each inhibitor. Our calculations revealed that structures with common functional groups showed similar binding characteristics, whereas structures with functional groups differing in hydrophilicity/hydrophobicity showed different types of intermolecular interactions for the same amino acid residues. Such analysis is expected to be effective for precise molecular design in structure-based drug design."

Journal • Infectious Disease • Influenza • Respiratory Diseases

In vitro efficacy of anti-influenza active compounds against clinical isolates with high growth capability. (PubMed, Arch Virol) - "In the present study, five anti-influenza agents-including four neuraminidase inhibitors (zanamivir, laninamivir, peramivir, and oseltamivir acid) and one polymerase acidic endonuclease inhibitor (baloxavir acid)-were evaluated against both a laboratory strain (PR8) and four clinical isolates lacking known resistance mutations...Effectiveness varies by the epidemic strains, likely due to unknown genetic factors. Further research is needed to identify these traits and improve diagnosis and treatment."

Journal • Preclinical • Infectious Disease • Influenza • Respiratory Diseases

Antiviral treatment for influenza. (PubMed, Philos Trans R Soc Lond B Biol Sci) - "NAIs, including oseltamivir, zanamivir, peramivir and laninamivir, block viral release, while polymerase inhibitors such as baloxavir disrupt viral RNA replication...Favipiravir and newer polymerase inhibitors are under investigation...Overall, timely antiviral use is critical to reducing influenza's burden. This article is part of the Theo Murphy meeting issue 'Evaluating anti-infective drugs'."

Journal • Review • Infectious Disease • Influenza • Respiratory Diseases

Association of severe abnormal behavior of influenza patients and administered anti-influenza virus drugs: 2006-2022. (PubMed, Int J Infect Dis) - "Findings indicate that oseltamivir alone does not raise risks of abnormal behavior among influenza patients."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Association of antiviral use for influenza among non-severe cases with subsequent hospitalization and mortality. (PubMed, BMC Med) - "Antiviral treatment was negatively associated with hospitalization, ICU admission, and mortality. The results need to be interpreted with caution, given limitations."

Journal • Critical care • Infectious Disease • Influenza • Respiratory Diseases

Influenza Virus Neuraminidase Glycoprotein, Its Inhibitors, and Their Resistance. (PubMed, Adv Exp Med Biol) - "This chapter provides an overview of the structure and function of NA and of four NA inhibitors-zanamivir, oseltamivir, peramivir, and laninamivir-that are widely used for the treatment and prophylaxis of influenza A and B viral infections. The importance of monitoring the emergence and global spread of NA inhibitor-resistant viruses is also discussed."

Journal • Review • Infectious Disease • Influenza • Respiratory Diseases

Influenza PA Substitutions and Genetic Diversity of A(H1N1)pdm09, A(H3N2), and B/Victoria Viruses in Japan During the 2023-2024 Season. (PubMed, Viruses) - "NA genes showed no substitutions associated with reduced susceptibility to laninamivir (e.g., E119A, G147E). Although pre-treatment PA/I38T was absent, low-frequency on-therapy selection was observed, including a rare PA/I38T in influenza B/Victoria detected by NGS, suggesting the value of deep sequencing when viral loads are low. These integrated genomic-clinical data support vaccine strain realignment for H3N2 and continued monitoring of baloxavir resistance in outpatient care."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Comprehensive evaluation of therapeutic effectiveness and safety profiles of baloxavir marboxil for managing influenza virus infection in pediatric populations: a systematic review with pooled meta-analytic data. (PubMed, Front Pediatr) - "A random-effects model meta-analysis demonstrated that, compared to neuraminidase inhibitors (oseltamivir, zanamivir, peramivir, laninamivir), baloxavir marboxil achieved accelerated resolution of febrile symptoms (MD = -13.16 h, 95% CI: -19.16 to -7.15, P < 0.0001)...However, continuous monitoring for baloxavir-resistant mutations (such as PA/I38T) in the pediatric population is warranted. Furthermore, confirmation through large-scale multicenter trials with extended follow-up periods remains warranted."

Journal • Review • Infectious Disease • Influenza • Pediatrics • Respiratory Diseases

Antiviral strategies against H5N1: current options and emerging therapeutics. (PubMed, Infection) - "This article provides a comprehensive, up-to-date overview of antiviral agents with established or investigational activity against H5N1, including both globally approved drugs and regionally licensed compounds, such as arbidol and triazavirin in Russia and laninamivir and favipiravir in Japan...The recent regulatory approvals of onradivir, suraxavir marboxil, and ZX-7101A in China are highlighted, along with emerging antivirals in advanced development...Challenges persist around resistance monitoring, access to novel therapies, and regulatory harmonization. Expanding the antiviral armamentarium through accelerated evaluation and integration of both traditional and innovative compounds will be essential to pandemic preparedness and effective H5N1 outbreak response."

Journal • Review • Infectious Disease • Influenza • Respiratory Diseases

Aryl benzoyl hydrazide derivatives as potent inhibitors of the NS2B-NS3 protease and RNA-dependent RNA polymerase of the zika virus. (PubMed, In Silico Pharmacol) - "To identify molecules that can strongly bind to the substrate binding site of the NS2B-NS3 protease of the ZIKV, interactions of several aryl benzoyl hydrazide (ABH) derivatives (10b, 10c, 10g, 11p, and 11q) and some anti-influenza drugs (Zanamivir, Laninamivir, Baloxavir, Oseltamivir, Rimantadine, Peramivir, and Amantadine) with the ZIKV NS2B-NS3 protease are studied herein by using combined density functional theoretic, docking, molecular dynamics (100 ns MD simulations), and free-energy methods...Computed ADMET parameters, Lipinski's rule of five, and binding affinities suggest that 11q would be a better drug candidate against ZIKV infections. The online version contains supplementary material available at 10.1007/s40203-025-00395-5."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Global update on the susceptibilities of influenza viruses to neuraminidase inhibitors and the cap-dependent endonuclease inhibitor baloxavir, 2020-2023. (PubMed, Antiviral Res) - "This study describes a global analysis of the susceptibility of influenza viruses to neuraminidase (NA) inhibitors (NAIs, oseltamivir, zanamivir, peramivir, laninamivir) and the cap-dependent endonuclease inhibitor (CENI, baloxavir) for three periods (May to May for 2020-2021, 2021-2022 and 2022-2023)...For zoonotic viruses, 2.7% (3/111) contained substitutions, one each NA-H275Y, NA-S247N and NA-N295S, associated with RI/HRI NAI phenotypes, and none contained PA substitutions associated with RS to baloxavir. In conclusion, the great majority of seasonal and zoonotic influenza viruses remained susceptible to NAIs and CENI baloxavir."

Journal • Infectious Disease • Influenza • Novel Coronavirus Disease • Respiratory Diseases

How to manage antivirals in critically ill patients with Influenza? (PubMed, Clin Microbiol Infect) - "Neuraminidase inhibitors constitute the vast majority of antivirals currently prescribed for influenza. The most commonly prescribed NAI to date is oseltamivir. While its efficacy in non-severe cases of influenza is well established, the evidence for its efficacy in critically ill patients is based on less robust studies, as no randomised controlled trials have been conducted in this population. Limited data on oseltamivir pharmacokinetics is available in critically ill patients. The selection of A(H1N1)pdm09 resistant variants to oseltamivir is particularly problematic in critically-ill patients hospitalised in intensive care units. Data on other antivirals, including NAIs (i.e., zanamivir, peramivir and laninamivir) or baloxavir marboxil in critically ill patients are scarce. Further research is needed to develop new drugs and assess their efficacy in critically ill patients and to better assess the effect of oseltamivir in this population."

Journal • Review • Critical care • Infectious Disease • Influenza • Respiratory Diseases

Antiviral Susceptibility of Influenza A(H5N1) Clade 2.3.2.1c and 2.3.4.4b Viruses from Humans, 2023-2024. (PubMed, Emerg Infect Dis) - "In the neuraminidase inhibition assay, all viruses displayed susceptibility to neuraminidase inhibitor antiviral drugs oseltamivir, zanamivir, peramivir, laninamivir, and AV5080...All viruses were susceptible to polymerase inhibitors baloxavir and tivoxavir and to polymerase basic 2 inhibitor pimodivir with 50% effective concentrations in low nanomolar ranges. Because drug-resistant viruses can emerge spontaneously or by reassortment, close monitoring of antiviral susceptibility of H5N1 viruses collected from animals and humans by using sequence-based analysis supplemented with phenotypic testing is essential."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Incidence of Severe Illness in Pediatric Influenza Outpatients Treated with Baloxavir or Neuraminidase Inhibitors. (PubMed, J Infect Chemother) - "Using a large, Japanese health insurance claims database, a lower rate of hospitalization was demonstrated in children aged 5-11 years with an influenza virus infection when treated with baloxavir vs neuraminidase inhibitors. Thus, single dose, oral baloxavir may reduce the incidence of severe illness in these patients."

Journal • Infectious Disease • Influenza • Pediatrics • Respiratory Diseases

In vitro neuraminidase inhibitory concentrations (IC50) of four neuraminidase inhibitors in the Japanese 2023-24 season: Comparison with the 2010-11 to 2022-23 seasons. (PubMed, J Infect Chemother) - "These results indicate that susceptibility to these four NAIs has been maintained across the three influenza types/subtypes over the past fourteen seasons in Japan."

Journal • Preclinical • Infectious Disease • Influenza • Respiratory Diseases

Pharmacologic background and clinical issue of anti-influenza drugs. (PubMed, Fukushima J Med Sci) - "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..."

Journal • Infectious Disease • Influenza • Pediatrics • Respiratory Diseases

A Pharmacoeconomic Study of Post-Exposure Prophylaxis Strategies for Influenza Virus Infections in Japan. (PubMed, Adv Ther) - "Baloxavir marboxil and oseltamivir are cost-effective prophylactic agents for flu from the perspective of healthcare costs in Japan. This strategy to select baloxavir marboxil or oseltamivir would be helpful to manage a formulary for post-exposure prophylaxis in Japan."

HEOR • Journal • Infectious Disease • Influenza • Respiratory Diseases

In persons exposed to influenza, zanamivir, oseltamivir, laninamivir, and baloxavir reduce symptomatic seasonal influenza. (PubMed, Ann Intern Med) - "2024;404:764-772. 39181596."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Virological and Clinical Outcomes of Influenza Outpatients Treated With Baloxavir, Oseltamivir, or Laninamivir in the 2023-2024 Season. (PubMed, Influenza Other Respir Viruses) - "Baloxavir-resistant variants were not detected in influenza BV before treatment, as with A. The emergence of PA-AA-substituted influenza A after baloxavir administration was temporal and did not cause prolonged symptoms. No baloxavir-resistant BV variants were observed after baloxavir administration."

Clinical data • Journal • Observational data • Infectious Disease • Influenza • Respiratory Diseases

The Synergistic Effect of Baloxavir and Neuraminidase Inhibitors against Influenza Viruses In Vitro. (PubMed, Viruses) - "Oseltamivir, a neuraminidase inhibitor, is a first-line anti-influenza drug, and baloxavir is part of the newest generation of anti-influenza drugs that targets the viral polymerase. The combination of baloxavir with NAIs led to significant synergistic effects; however, the combination of baloxavir with laninamivir failed to result in a synergistic effect on influenza B viruses. Considering the rapid emergence of drug resistance to baloxavir, we believe that these results will be beneficial for combined drug use against influenza."

Journal • Preclinical • Infectious Disease • Influenza • Respiratory Diseases

Identification of Potential Tryptase Inhibitors from FDA-Approved Drugs Using Machine Learning, Molecular Docking, and Experimental Validation. (PubMed, ACS Omega) - "Our results demonstrated that several FDA-approved drugs, including landiolol, laninamivir, and cidofovir, significantly inhibited tryptase activity. These findings not only underscore the potential of ML in accelerating drug repurposing but also highlight the feasibility of this approach in identifying effective tryptase inhibitors. This research contributes to the field of drug discovery, offering a novel pathway to expedite the development of therapeutics for tryptase-related pathologies."

FDA event • Journal • Machine learning • Allergy • Hematological Malignancies • Leukemia • Oncology

Occurrence and environmental fate of anti-influenza drugs in a subcatchment of the Yodo River Basin, Japan. (PubMed, Sci Total Environ) - "In this study, the behaviour of the prodrug baloxavir marboxil (BALM)-the active ingredient of Xofluza, an increasingly popular anti-influenza drug-and its pharmacologically active metabolite baloxavir (BAL) in the aquatic environment was evaluated. Additionally, their presence in urban rivers and a wastewater treatment plant (WWTP) in the Yodo River basin was investigated and compared with those of the major anti-influenza drugs used to date (favipiravir (FAV), peramivir (PER), laninamivir (LAN), and its active metabolite, laninamivir octanoate (LANO), oseltamivir (OSE), and its active metabolite, oseltamivir carboxylate (OSEC), and zanamivir (ZAN)) to comprehensively assess their environmental fate in the aquatic environment...Notably, all anti-influenza drugs were effectively removed by ozonation (>90-99.9 % removal) after biological treatment at a WWTP. Thus, these findings suggest the importance of introducing ozonation to reduce pollution loads in rivers and the..."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Antivirals for post-exposure prophylaxis of influenza: a systematic review and network meta-analysis. (PubMed, Lancet) - "Post-exposure prophylaxis with zanamivir, oseltamivir, laninamivir, or baloxavir probably decreases the risk of symptomatic seasonal influenza in individuals 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."

Clinical • Journal • Retrospective data • Review • Infectious Disease • Influenza • Respiratory Diseases