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Meta-Analysis
. 2025 Jun 23;20(6):e0326777.
doi: 10.1371/journal.pone.0326777. eCollection 2025.

Clinical efficacy and Safety of Baloxavir Marboxil compared with Oseltamivir against influenza virus in children: A systematic review and meta-analysis

Ling Zhu  1 , Li Zhong  2 , Guidong Huang  1   3   4
Affiliations
Meta-Analysis

Clinical efficacy and Safety of Baloxavir Marboxil compared with Oseltamivir against influenza virus in children: A systematic review and meta-analysis

Ling Zhu et al. PLoS One. .

Abstract

Objective: Comparing the clinical efficacy and safety of baloxavir marboxil and oseltamivir against influenza viruses in children, to provide theoretical references for clinical practice.

Methods: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, Epistemonikos, CNKI, Wipu.com, Wan Fang Database, and China Biomedical Literature Database for articles published up to December 25th, 2024, was conducted. After literature screening, data extraction, and quality evaluation, descriptive analysis was performed.

Results: Eight papers were included, comprising three randomized controlled studies and Five cohort studies, involving 3141 patients (1745 in the baloxavir marboxil group and 1396 in the oseltamivir group). Meta-analysis revealed no significant differences in time to remission of influenza symptoms and duration of fever between the two groups. However, baloxavir marboxil demonstrated a significantly greater reduction in influenza virus titer and RNA load. Additionally, the incidence of adverse events was significantly lower with baloxavir marboxil (p = 0.03).

Conclusions: Baloxavir marboxil appears more effective than oseltamivir in reducing viral load and is associated with fewer adverse events in children with influenza, while both drugs yield comparable effects in relieving symptoms. Given the limited number of included studies and absence of subgroup analyses, further well-designed trials are needed to corroborate these findings. PROSPERO Registration Number: CRD42024565338.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of literature screening.
Fig 2
Fig 2. Diagram of risk of bias assessment for randomized controlled studies.
Fig 3
Fig 3. Forest plot of Meta-analysis of time to remission of influenza symptoms in randomized controlled studies.
Fig 4
Fig 4. Forest plot of Meta-analysis of time to remission of influenza symptoms in cohort studies.
Fig 5
Fig 5. Forest plot of Meta-analysis of fever duration in randomized controlled studies.
Fig 6
Fig 6. Forest plot of Meta-analysis of fever duration in cohort studies.
Fig 7
Fig 7. Forest plot of Meta-analysis of the change in viral titer from baseline to the next day in a randomized controlled study.
Fig 8
Fig 8. Forest plot of Meta-analysis of the change in viral RNA load from baseline to the next day in a randomized controlled study.
Fig 9
Fig 9. Forest plot of Meta-analysis of the incidence of any adverse reactions in randomized controlled studies.
Fig 10
Fig 10. Forest plot of Meta-analysis of incidence of serious adverse reactions in randomized controlled studies.
See this image and copyright information in PMC

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