Antivirals for treatment of severe influenza: a systematic review and network meta-analysis of randomised controlled trials

Influenza, a viral respiratory disease, typically causes mild to moderate upper respiratory symptoms that resolve within a week.1–3 However, a substantial proportion of individuals, particularly those in groups at high risk, such as young children (<5 years), older adults (≥65 years), pregnant women, and people with chronic medical conditions, can develop severe illness from influenza.1,4

Influenza is an important cause of respiratory viral disease among hospitalised patients, resulting in hundreds of thousands of respiratory deaths worldwide annually, and major economic losses.5–8 Hospitalised patients with seasonal influenza can develop complications, including severe pneumonia, respiratory failure, multi-organ failure, and secondary bacterial infections, that can lead to death.1,9–12 The case-fatality proportion for adults hospitalised with influenza typically ranges from 4% to 8%, but might be higher (10–15% or higher) during rare pandemics and among immunocompromised individuals.13 Therefore, identifying effective therapies for severe influenza is of global public health importance.