Antivirals for post-exposure prophylaxis of influenza: systematic review and network meta-analysis

Antiviral post-exposure prophylaxis with neuraminidase inhibitors can reduce the incidence of influenza and the risk of symptomatic influenza, but the efficacy of other classes of antivirals remains uncertain. To support an update of WHO guidelines on influenza, this systematic review and network meta-analysis evaluated antiviral drugs for post-exposure prophylaxis of influenza.

The authors systematically searched MEDLINE, Embase, the Cochrane Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, Global Health, Epistemonikos and ClinicalTrials.gov for randomised controlled trials published up to 20 September 2023 that assessed the efficacy and safety of antivirals compared with another antiviral or placebo or standard care for the prevention of influenza. Pairs of reviewers independently examined the studies, extracted the data and assessed the risk of bias. They performed network meta-analyses with the frequentist random effects model and assessed the confidence level of the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. The outcome measures of interest were symptomatic or asymptomatic infection, hospital admission, all-cause mortality, antiviral-related adverse events and serious adverse events. This study is registered with PROSPERO, CRD42023466450.