Baloxavir for the treatment of Influenza in allogeneic hematopoietic stem cell transplant recipients previously treated with oseltamivir.
Aged
Antiviral Agents
/ therapeutic use
Dibenzothiepins
/ therapeutic use
Drug Resistance, Viral
Enzyme Inhibitors
/ therapeutic use
Female
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Immunocompromised Host
Influenza, Human
/ drug therapy
Male
Middle Aged
Morpholines
/ therapeutic use
Oseltamivir
/ therapeutic use
Pyridones
/ therapeutic use
Transplant Recipients
Treatment Outcome
Triazines
/ therapeutic use
Virus Shedding
/ drug effects
antiviral resistance
baloxavir marboxil
influenza A virus
neuraminidase inhibitors
oseltamivir
stem cell transplant
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
21
03
2020
accepted:
15
05
2020
pubmed:
26
5
2020
medline:
8
6
2021
entrez:
26
5
2020
Statut:
ppublish
Résumé
Seasonal influenza causes significant morbidity and mortality in allogeneic stem cell transplant (SCT) recipients. In this population, influenza virus can replicate for prolonged periods, despite neuraminidase inhibitor treatment, leading to resistance and treatment failure. Baloxavir targets the influenza polymerase and may be an effective treatment option in these patients. We used baloxavir to treat five allogeneic SCT recipients that were still symptomatic and shedding influenza virus after completing one or more treatment courses of oseltamivir and characterized the viral isolates before and during treatment. Two patients were infected with influenza A/H1pdm09 carrying a neuraminidase variant (H275Y) linked to oseltamivir resistance. Both these two patients were successfully treated with baloxavir. Of the three patients infected with wild-type influenza virus, two cleared the virus after baloxavir treatment, while the third patient developed the polymerase I38T variant linked to baloxavir resistance. Our data suggest that baloxavir treatment can be effective in treating neuraminidase inhibitor-resistant influenza in profoundly immunocompromised patients. Randomized clinical trials are needed to define the role of baloxavir alone and combined with oseltamivir for the treatment of influenza in SCT recipients and other immunocompromised populations.
Sections du résumé
BACKGROUND
BACKGROUND
Seasonal influenza causes significant morbidity and mortality in allogeneic stem cell transplant (SCT) recipients. In this population, influenza virus can replicate for prolonged periods, despite neuraminidase inhibitor treatment, leading to resistance and treatment failure. Baloxavir targets the influenza polymerase and may be an effective treatment option in these patients.
METHODS
METHODS
We used baloxavir to treat five allogeneic SCT recipients that were still symptomatic and shedding influenza virus after completing one or more treatment courses of oseltamivir and characterized the viral isolates before and during treatment.
RESULTS
RESULTS
Two patients were infected with influenza A/H1pdm09 carrying a neuraminidase variant (H275Y) linked to oseltamivir resistance. Both these two patients were successfully treated with baloxavir. Of the three patients infected with wild-type influenza virus, two cleared the virus after baloxavir treatment, while the third patient developed the polymerase I38T variant linked to baloxavir resistance.
CONCLUSIONS
CONCLUSIONS
Our data suggest that baloxavir treatment can be effective in treating neuraminidase inhibitor-resistant influenza in profoundly immunocompromised patients. Randomized clinical trials are needed to define the role of baloxavir alone and combined with oseltamivir for the treatment of influenza in SCT recipients and other immunocompromised populations.
Substances chimiques
Antiviral Agents
0
Dibenzothiepins
0
Enzyme Inhibitors
0
Morpholines
0
Pyridones
0
Triazines
0
Oseltamivir
20O93L6F9H
baloxavir
4G86Y4JT3F
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13336Informations de copyright
© 2020 Wiley Periodicals LLC.
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