Rapivab (peramivir) / BioCryst Pharmaceuticals, Shionogi - LARVOL DELTA

A study on the efficacy of anti-influenza drugs, intravenous peramivir against influenza virus infections. (clinicaltrials.gov) - P=N/A | N=50 | Completed | Sponsor: Department of Clinical Infectious Diseases, Aichi Medical University Hospital | Unknown status ➔ Completed

Trial completion • Infectious Disease • Influenza • Respiratory Diseases

Occurrence of influenza antivirals and resistance development in influenza A viruses in aquatic environments: A risk assessment. (PubMed, PLoS One) - "This study aimed to assess the environmental risk posed by four IAs-oseltamivir carboxylate (OC), zanamivir (ZA), peramivir (PE), and amantadine (AM)-based on their potential for environmental release, environmental stability, and induction of antiviral resistance...However, in uncomplicated influenza among otherwise healthy individuals, the clinical benefit is limited, and the risk of resistance development should be carefully considered. Among the evaluated antivirals, ZA showed the lowest environmental risk and should be preferred when feasible."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Efficacy and Safety of Inhaled Peramivir Solution for the Treatment of Adults With Uncomplicated Influenza (clinicaltrials.gov) - P3 | N=600 | Not yet recruiting | Sponsor: Capital Medical University

New P3 trial • Infectious Disease • Influenza • Respiratory Diseases

Antiviral Dispensing for Influenza Outpatients Younger Than 65 Years With Comorbidities: A Retrospective Cohort Study. (PubMed, Open Forum Infect Dis) - "Antiviral treatment was defined as dispensing of oseltamivir, peramivir, zanamivir, or baloxavir within 7 days of the encounter...About half of higher-risk influenza outpatients received antivirals. Overall dispensing was similar by insurance type, but Medicaid patients and those with multiple UMCs had greater delays."

Journal • Retrospective data • Infectious Disease • Influenza • Pulmonary Disease • Respiratory Diseases

Characterization of oseltamivir-resistant A(H5N1) clade 2.3.4.4b, genotype D1.1 variants identified in poultry farms of British Columbia, Canada. (PubMed, Emerg Microbes Infect) - "Neuraminidase inhibitor (NAI) susceptibility was determined by NA inhibition assays, whereas susceptibility to baloxavir acid (BXA) was evaluated by plaque reduction assay...Viral titers in lungs, brain, nose, kidney, spleen, and heart were quantified at day 4 p.i. The BC-H5N1-WT virus was susceptible to the four antivirals tested, whereas BC-H5N1-H275Y displayed resistance to oseltamivir and peramivir but remained susceptible to zanamivir and BXA...In mice, BC-H5N1-WT was more virulent with LD50 values of 1.78 × 103 PFUs compared to 8.71 × 104 PFUs for BC-H5N1-H275Y, and produced higher viral titers in lungs and other organs. Despite the reduced fitness of the resistant H5N1 D1.1 variant, its emergence in the absence of viral selection pressure underscores the need for continued surveillance."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Influenza Antiviral Prescriptions in the US Inpatient and Outpatient Settings During the 2015-2022 Influenza Seasons. (PubMed, Influenza Other Respir Viruses) - "Among US insured individuals, oseltamivir remained the most prescribed antiviral during the 2016-2017 through 2022-2023 seasons, a pattern consistent with its broader FDA-approved indication across age groups and care settings relative to baloxavir, peramivir, and zanamivir."

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

Signal mining of adverse reactions for neuraminidase inhibitors in pregnant women: a disproportionality analysis based on the FDA adverse event reporting system database. (PubMed, Front Med (Lausanne)) - "From Q1 2004 to Q3 2025, a total of 3,687 ADE reports were retrieved in this study, including 3,211 reports for oseltamivir, 471 reports for zanamivir, and 5 reports for peramivir...The study findings align with current guidelines recommending neuraminidase inhibitors as the primary antiviral treatment of pregnant women with influenza. Our study may offer valuable evidence to support the clinical use of neuraminidase inhibitors, particularly in identifying adverse events and ensuring their safe administration in women during pregnancy."

Adverse events • Journal • Acne Vulgaris • Gastrointestinal Disorder • Infectious Disease • Influenza • Perinatal Disorders • Respiratory Diseases

Antivirals Improve Outcomes in Influenza. (PubMed, Emerg Med Clin North Am) - "Antivirals like neuramidase inhibitors (oseltamivir, zanamivir, and peramivir) and endonuclease inhibitors (baloxavir) can help with treatment when started within 48 hours of symptom onset, primarily shortening illness duration by about 1 day...elerly, pregnant and immunocompromized). However, for healthy, low-risk outpatients, the clinical benefit is modest, adn the risk of side effects is high."

Journal • Review • Infectious Disease • Influenza • 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

Rapid progression from croup to complete lung collapse: a case report of central airway obstruction by mucopurulent cast in influenza A (H3N2) and Pseudomonas aeruginosa coinfection in a toddler. (PubMed, Front Pediatr) - "Etiological analysis confirmed co-infection with influenza A virus (H3N2) and Pseudomonas aeruginosa. The patient was treated with sensitive antibiotics and peramivir, and was discharged on day 9 with no recurrence of symptoms."

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

A Study to Evaluate the Efficacy and Safety of Intravenous Peramivir in Subjects With Uncomplicated Influenza. (clinicaltrials.gov) - P3 | N=0 | Withdrawn | Sponsor: BioCryst Pharmaceuticals | Terminated ➔ Withdrawn

Trial withdrawal • 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

A mouse model of human-derived H10N3 influenza enables preclinical evaluation of antiviral efficacy. (PubMed, Antiviral Res) - "Neuraminidase inhibitors (oseltamivir or peramivir) effectively conferred protection for H10N3 low-lethal infection, but the efficacy of peramivir is superior to that of oseltamivir. One single dose of baloxavir marboxil (BM) treatment at 2 h post-infection provides complete protection against mortality, but BM treatment with a 24h delay has no protective effect against mortality caused by H10N3 virus infection...However, both in vitro and in vivo combination of BM with NAIs exhibit significant additive effect against H10N3 virus infection than BM or NAIs monotherapy. Our findings suggest that combination of BM with NAIs represents a promising therapeutic strategy for emerging H10N3 infections in clinical practice."

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

A Case of Acute Necrotizing Encephalopathy in a Patient With Influenza (AAN 2026) - "Background This is a 57-year old-female with seronegative lupus (on hydroxychloroquine and belimumab) who presented with acute onset dysarthria and gait instability...She tested positive for Influenza A and oseltamivir was started, later changed to peramivir...Pathophysiology has not been entirely characterized but is thought to involve a cytokine storm in susceptible hosts. Prompt identification is essential so that high-dose steroids, plasmapheresis, tocilizumab, and/or intravenous immunoglobulin can be initiated."

Clinical • Acute Lung Injury • Cardiovascular • CNS Disorders • Epilepsy • Glomerulonephritis • Immunology • Infectious Disease • Inflammatory Arthritis • Influenza • Lupus • Lupus Nephritis • Nephrology • Respiratory Diseases • IL6

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

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

Isolation, identification, and whole genome sequencing analysis of influenza A virus clinical isolates from Shanghai, China, during 2022-2023. (PubMed, Virol J) - "Mutational analysis identified key substitutions in the hemagglutinin and neuraminidase regions, including the I222V mutation in the neuraminidase segment of sample B623080303, which is associated with strong resistance to oseltamivir and peramivir. Another highly drug-resistant N206D mutation in the hemagglutinin region, detected in four clinical isolates, was found to alter host specificity by reducing binding affinity to human-like α2,6-linked receptors while increasing affinity for avian-like α2,3-linked receptors, thereby influencing host adaptation dynamics. The findings provide critical insights into the evolutionary trends of influenza A virus strains post-COVID-19 pandemic and their potential implications for vaccine effectiveness and antiviral resistance."

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

Integrated Phenotypic-Genotypic Surveillance of Neuraminidase Inhibitor Susceptibility in Influenza A(H1N1), A(H3N2), and B/Victoria Viruses in Saudi Arabia, 2024-2025. (PubMed, J Med Virol) - "Influenza B virus displayed a reproducible oseltamivir right-shift linked to non-canonical framework/interface substitutions, whereas zanamivir and especially peramivir retained activity. These findings support ongoing integrated phenotype-genotype surveillance and consideration of peramivir when influenza B circulation is substantial."

Journal • Infectious Disease • Influenza • Respiratory Diseases

Theoretical, biological, and electrochemical explanation of the complexity of Peramivir's drug-DNA interaction. (PubMed, Sci Rep) - "Complementarily plasmid relaxation assays indicate that PMV does not cause significant DNA damage such as single- or double-strand breaks, but also does not provide any protection against oxidative DNA damage. These findings imply that the drug's mechanism of action is centred more on molecular interaction with DNA rather than on compromising its structural integrity."

Journal • Infectious Disease • Influenza • Respiratory Diseases

A literature review of influenza chemoprophylaxis and treatment in children. (PubMed, Germs) - "In Europe, oseltamivir, zanamivir, and baloxavir marboxil are recommended for the treatment or prophylaxis of influenza in adults and children, while the Food and Drug Administration added intravenous peramivir to the list of anti-influenza drugs...However, there are still discussions related to the duration of prophylaxis, with shorter periods of administration being explored, or the most efficient treatment dosage program (whether it is the conventional dosage of 3 mg/kg/dose for children <40 kg or 75 mg for adults, twice daily, compared to a double dosage administration program). When faced with an old disease, it is essential to constantly assess the efficacy of conventional molecules and dosages, along with new antivirals or complementary medication."

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

The Republic of Korea 2023-2024 Influenza and Respiratory Viruses Laboratory Surveillance Report (PubMed, Jugan Geongang Gwa Jilbyeong) - "Further, no mutations associated with resistance to antiviral drugs (Oseltamivir, Zanamivir, and Peramivir, Baloxavir) were identified...The continuous surveillance of influenza and respiratory virus trends is essential to inform vaccine strain selection and enhance public health response strategies. Our division will conduct continuous surveillance of the epidemiological trends of respiratory viruses, including influenza, and ensure the timely provision of data for public health interventions."

Journal • Infectious Disease • Influenza • Novel Coronavirus Disease • Respiratory Diseases • Respiratory Syncytial Virus Infections