Comparative Effectiveness and Safety of Oseltamivir, Baloxavir, and Peramivir in Children with Influenza A/B: A Propensity-Matched Cohort Study
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: Background: Comparative evidence on pediatric influenza antivirals is limited. We compared clinical features of influenza A and B and evaluated oseltamivir, baloxavir marboxil, and peramivir. Methods: Retrospective cohort of 3,718 children (A, n=1,717; B, n=2,001) from November 2023—April 2024. Patients were grouped by virus and regimen; propensity score matching balanced covariates. Outcomes were time to fever resolution, recovery, and adverse events. Results: Influenza A showed higher fever and more cough and neurologic complications; influenza B had more gastrointestinal symptoms. In A, baloxavir shortened fever versus oseltamivir by 0.54 days (1.57 vs 2.11), and peramivir by 0.51 days (1.72 vs 2.23); peramivir also shortened recovery (6.70 vs 7.19). In B, baloxavir and peramivir shortened fever by 0.79 days (1.50 vs 2.29) and 0.54 days (1.71 vs 2.25) versus oseltamivir; recovery was also shorter (6.83 vs 7.20; 6.68 vs 7.09). Baloxavir outperformed peramivir for fever in B by 0.23 days (1.55 vs 1.78). AE rates were 16.5% with oseltamivir, 5.0% with peramivir, and 3.6% with baloxavir; events were mild–moderate, with none severe. Treatment regimen and pneumonia predicted fever resolution; pneumonia and fever duration predicted recovery. Conclusions: Clinical phenotypes differ between A and B. Baloxavir and peramivir provided superior efficacy and tolerability to oseltamivir. For children ≥5 years or when adherence is a concern, single-dose baloxavir is practical; for those unable to take oral agents or with severe disease, intravenous peramivir is preferred. Oseltamivir remains widely used for chemoprophylaxis. Findings support stratified antiviral selection in pediatric practice.
Authors: Yanning Qu, Zhuyan Duan, Mengyi Sheng, Hui Wang, Jing Yuan, Jinghua Cui, Lin Wang, Linying Guo
Institution: Capital Institute of Pediatrics
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4414973960
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