Discussion on newer NI's in the British Medical Journal as a result of the updated Cochrane Report on older NI's:
"The updated Cochrane review concluded that oseltamivir and zanamivir reduce the duration of influenza symptoms but do not reduce influenza-related complications and hospital admissions [1-3]. Although the Cochrane review authors did not review efficacy of newer neuraminidase inhibitors (NIs), they stated, "laninamivir and peramivir may be more potent as NIs, because their bioavailability is far higher than zanamivir and may affect the host’s endogenous neuraminidase [1]."
The Table shows a summary of published and unpublished clinical trials of laninamivir and peramivir for influenza in healthy adults in Japan and other East Asian countries [4-7]. All of these trials were conducted in two consecutive influenza seasons before the 2009 pandemic. Although both laninamivir and peramivir demonstrated a significant reduction in symptom duration, without increasing the risk of adverse events, no data supported the superiority of the newer NIs over oseltamivir, including limited information of physician-diagnosed influenza-related complications; the risks of complications in the 300-mg- and 600-mg-peramivir groups did not significantly differ from that in the oseltamivir-group (2.7%, 2.5%, and 3.3%, respectively) [7].
Japan is the leading NI-consuming country and has prescribed 75% of all oseltamivir worldwide [8 9]. Laninamivir and preramivir were first approved in Japan in 2010 and have already been widely marketed there [10 11]. A recent report showed that in the 2012-13 influenza season, Japanese clinicians prescribed laninamivir for 42% of adult influenza patients, oseltamivir for 41%, peramivir for 12%, and zanamivir for 5% [12]. The Cochrane review reminded us of the importance of having independent scrutiny of data contained in clinical study reports. Such an evaluation should help provide further information to answer the question of whether the newer NIs are truly more potent or not. "
Its worth having a look at the linked table. It shows a Phase 2 placebo trial for Lani with a very significant reduction in time to symptom relief.
