Inhaled Laninamivir Octanoate for Influenza Prophylaxis in Children—Does it work?
DrLewisFirst, MD, MA, Editor-in-Chief, Pediatrics
The use of an anti-influenza pharmaceutical agent laninamivir octanoate, a long –acting
neuraminidase inhibitor, has been shown in adults to effectively prophylax against
this virus after flu exposure, although it is not as effective a prevention strategy
as getting the vaccine itself. So what about children? Can it play a role in prophylaxis
in this younger population?
Since this had not yet been shown in the clinical effectiveness trials done to date,
Nakano et al. (10.1542/peds.2016-0109) performed a double-blind multicenter placebo-controlled trial to see if this drug
could prevent the development of influenza when used in 343 randomized children less
than 10 years of age exposed to an index case regardless of whether or not they had
received vaccine. The authors’ outcome measure was the development of influenza within
a 10-day period of the index case itself being diagnosed. The results showed less
breakthrough of influenza in those who got the laninamivir octanoate as a single dose
of 20 mg compared to those who got placebo.
While you may not find that you want to use this drug in the future (which needs to
be started within 48 hours of contact with an index case), and turn instead to oseltamivir
or zanamivir which need to be dosed more frequently than laninamivir, this study offers
the opportunity to consider a single-dosed drug with some nice results at least according
to this study. To add further import to the findings, Drs. Flor Munoz and Henry (Hank)
Bernstein (10.1542/peds.2016-2371) from the Committee on Infectious Diseases for the AAP share a commentary on why
this study may bode well for the future. To see whether inhaled laninamivir becomes
a mainstay in addition to the influenza vaccine for preventing disease in those exposed
to the virus, read the study and commentary for yourself. You’re likely to find both
nothing to sneeze at.